Provider First Line Business Practice Location Address:
28 W BROAD 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:
18634-2203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-735-1100
Provider Business Practice Location Address Fax Number:
570-740-1386
Provider Enumeration Date:
03/22/2007