Provider First Line Business Practice Location Address:
113 S 2ND 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:
17872-6606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-648-1416
Provider Business Practice Location Address Fax Number:
570-648-7247
Provider Enumeration Date:
07/20/2005