Provider First Line Business Practice Location Address:
610 WYOMING AVE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704-3702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-288-6627
Provider Business Practice Location Address Fax Number:
570-288-6699
Provider Enumeration Date:
08/14/2006