Provider First Line Business Practice Location Address:
401 UNIVERSITY DR
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:
17972-2211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-593-6725
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2011