Provider First Line Business Practice Location Address:
1666 MOUNT HOPE AVE
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:
17901-1302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-581-8218
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/05/2013