Provider First Line Business Practice Location Address:
121 S PROSPECT 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:
18634-2456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-735-7590
Provider Business Practice Location Address Fax Number:
570-836-3118
Provider Enumeration Date:
07/12/2006