Provider First Line Business Practice Location Address:
425 KOSCIUSZKO 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:
18634-2698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-735-1701
Provider Business Practice Location Address Fax Number:
570-733-1003
Provider Enumeration Date:
05/03/2007