Provider First Line Business Practice Location Address:
450 N CLAUDE A LORD 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:
17901-2706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-622-1025
Provider Business Practice Location Address Fax Number:
570-628-4344
Provider Enumeration Date:
12/21/2005