Provider First Line Business Practice Location Address:
201 N SPRAGUE 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:
18704-3506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-710-4030
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2022