Provider First Line Business Practice Location Address:
541 N FRANKLIN ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SHAMOKIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17872-6754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-644-2000
Provider Business Practice Location Address Fax Number:
570-644-9801
Provider Enumeration Date:
08/22/2012