Provider First Line Business Practice Location Address:
26 S CENTRE 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:
17901-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-622-5751
Provider Business Practice Location Address Fax Number:
570-628-0841
Provider Enumeration Date:
02/26/2019