Provider First Line Business Practice Location Address:
3090 N SUSQUEHANNA TRAIL RD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-743-3937
Provider Business Practice Location Address Fax Number:
570-743-3005
Provider Enumeration Date:
03/30/2009