Provider First Line Business Practice Location Address:
21 W INDEPENDENCE 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:
17872-5313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-648-8989
Provider Business Practice Location Address Fax Number:
570-648-8886
Provider Enumeration Date:
11/19/2005