Provider First Line Business Practice Location Address:
121 PROGRESS AVE STE 120S
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:
17901-2968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-622-5622
Provider Business Practice Location Address Fax Number:
570-622-5618
Provider Enumeration Date:
02/28/2015