Provider First Line Business Practice Location Address:
205 E LAUREL BLVD
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:
17901-2534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-624-4743
Provider Business Practice Location Address Fax Number:
570-501-7028
Provider Enumeration Date:
10/27/2019