Provider First Line Business Practice Location Address:
3040 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:
17876-9113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-743-1703
Provider Business Practice Location Address Fax Number:
570-743-1728
Provider Enumeration Date:
02/14/2012