Provider First Line Business Practice Location Address:
147 OLD NEWPORT ST
Provider Second Line Business Practice Location Address:
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:
570-740-5391
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2011