Provider First Line Business Practice Location Address:
517 PIERCE ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704-5731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-718-1988
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2005