Provider First Line Business Practice Location Address:
3057 N SUSQUEHANNA TRL
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:
17876-9114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-743-1112
Provider Business Practice Location Address Fax Number:
570-743-2045
Provider Enumeration Date:
08/02/2021