Provider First Line Business Practice Location Address:
480 PIERCE STREET
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-718-1996
Provider Business Practice Location Address Fax Number:
570-718-1997
Provider Enumeration Date:
11/01/2006