Provider First Line Business Practice Location Address:
523 S GARFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHUYLKILL HAVEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17972-1107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-385-3826
Provider Business Practice Location Address Fax Number:
570-385-4125
Provider Enumeration Date:
11/17/2005