Provider First Line Business Practice Location Address:
500 N CENTRE STREET SUITE 104
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-516-9987
Provider Business Practice Location Address Fax Number:
570-581-5103
Provider Enumeration Date:
02/21/2007