Provider First Line Business Practice Location Address:
21 BALDWIN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHAMOKIN DAM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17876-9514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-743-3300
Provider Business Practice Location Address Fax Number:
570-743-7555
Provider Enumeration Date:
02/02/2016