Provider First Line Business Practice Location Address:
339 W WALNUT 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:
17872-5225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-648-7669
Provider Business Practice Location Address Fax Number:
570-644-3979
Provider Enumeration Date:
11/19/2018