Provider First Line Business Practice Location Address:
118 S 2ND ST STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POTTSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17901-3181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-516-8553
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/18/2025