Provider First Line Business Practice Location Address:
396 S CENTRE ST
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
POTTSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17901-3596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-709-2389
Provider Business Practice Location Address Fax Number:
570-516-9344
Provider Enumeration Date:
03/28/2007