Provider First Line Business Practice Location Address:
4 N 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHAMOKIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17872-5210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-644-2353
Provider Business Practice Location Address Fax Number:
570-644-2392
Provider Enumeration Date:
09/15/2005