Provider First Line Business Practice Location Address:
1003 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:
17872-4629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-648-7029
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2007