Provider First Line Business Practice Location Address:
420 S JACKSON ST
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:
17901-3625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-621-5142
Provider Business Practice Location Address Fax Number:
570-621-5113
Provider Enumeration Date:
02/12/2007