Provider First Line Business Practice Location Address:
12 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:
17872-5314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-648-6441
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2006