Provider First Line Business Practice Location Address:
40 N MARKET 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:
18634-1411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-735-2315
Provider Business Practice Location Address Fax Number:
570-735-9171
Provider Enumeration Date:
01/10/2006