Provider First Line Business Practice Location Address:
250 PIERCE ST
Provider Second Line Business Practice Location Address:
STE 214
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704-5149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-718-1761
Provider Business Practice Location Address Fax Number:
570-718-1763
Provider Enumeration Date:
06/16/2005