Provider First Line Business Practice Location Address:
3120 N OLD TRL STE A
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:
17876-9428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-374-3668
Provider Business Practice Location Address Fax Number:
570-374-7306
Provider Enumeration Date:
12/01/2005