Provider First Line Business Practice Location Address:
515 517 MARKET STREET
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:
18704-4535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-283-0691
Provider Business Practice Location Address Fax Number:
570-283-4836
Provider Enumeration Date:
12/04/2006