Provider First Line Business Practice Location Address:
5879 STATE ROUTE 92 STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18826-9707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-222-5005
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2022