Provider First Line Business Practice Location Address:
445 WEST MAIN STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-258-5002
Provider Business Practice Location Address Fax Number:
570-904-8838
Provider Enumeration Date:
04/18/2016