Provider First Line Business Practice Location Address:
216 N 12TH 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:
17901-2243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-617-9973
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2012