Provider First Line Business Practice Location Address:
615 N SHAMOKIN 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:
17872-6719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-898-5072
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2024