Provider First Line Business Practice Location Address:
680 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHUYLKILL HAVEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17972-1428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-385-4455
Provider Business Practice Location Address Fax Number:
570-385-7273
Provider Enumeration Date:
02/10/2006