Provider First Line Business Practice Location Address:
693 PORT CARBON SAINT CLAIR HWY
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:
17901-8604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-429-1432
Provider Business Practice Location Address Fax Number:
570-429-1019
Provider Enumeration Date:
02/03/2017