Provider First Line Business Practice Location Address:
281 E RIDGE 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:
18634-2814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-899-3463
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2026