Provider First Line Business Practice Location Address:
113 W INDEPENDENCE 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:
17872-5315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-644-3900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/12/2020