Provider First Line Business Practice Location Address:
128 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
NANTICOKE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18634-3113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-258-0111
Provider Business Practice Location Address Fax Number:
570-258-0303
Provider Enumeration Date:
10/15/2008