Provider First Line Business Practice Location Address:
401 UNIVERSITY DR
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:
17972-2211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-385-0331
Provider Business Practice Location Address Fax Number:
570-385-5617
Provider Enumeration Date:
03/25/2007