Provider First Line Business Practice Location Address:
301 SUNSHINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHICKSHINNY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18655-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-417-5504
Provider Business Practice Location Address Fax Number:
570-542-7877
Provider Enumeration Date:
12/24/2025