Provider First Line Business Practice Location Address:
45 US-11
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:
17876-5127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-931-3849
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2008