Provider First Line Business Practice Location Address:
124 S HANOVER ST REAR
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:
18634-2219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-592-3702
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2022