Provider First Line Business Practice Location Address:
395 N MAPLE AVE
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:
18704-3614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-288-6561
Provider Business Practice Location Address Fax Number:
570-287-3248
Provider Enumeration Date:
02/24/2007