Provider First Line Business Practice Location Address:
147 OLD NEWPORT ST
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
NANTICOKE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18634-1327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-812-0300
Provider Business Practice Location Address Fax Number:
570-812-0030
Provider Enumeration Date:
03/15/2007