Provider First Line Business Practice Location Address:
2660 N SUSQUEHANNA TRL
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:
17876-9105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-884-3726
Provider Business Practice Location Address Fax Number:
570-884-3728
Provider Enumeration Date:
01/26/2010