Provider First Line Business Practice Location Address:
128 W WASHINGTON 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:
18634-3113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-534-7888
Provider Business Practice Location Address Fax Number:
718-874-0088
Provider Enumeration Date:
03/10/2020