Provider First Line Business Practice Location Address:
1410 LAUREL BLVD STE 2
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:
17901-1415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-628-5374
Provider Business Practice Location Address Fax Number:
570-628-4809
Provider Enumeration Date:
03/06/2019