Provider First Line Business Practice Location Address:
35 E GREEN 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:
18634-2414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-762-2583
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2019