Provider First Line Business Practice Location Address:
693 W MARKET ST
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:
18704-3422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-714-5665
Provider Business Practice Location Address Fax Number:
570-714-5660
Provider Enumeration Date:
03/21/2007