Provider First Line Business Practice Location Address:
445 WYOMING AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-718-0505
Provider Business Practice Location Address Fax Number:
570-718-0522
Provider Enumeration Date:
02/23/2006