Provider First Line Business Practice Location Address:
RR 1 BOX 458
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:
17872-9721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-797-1000
Provider Business Practice Location Address Fax Number:
570-797-4977
Provider Enumeration Date:
08/24/2007