Provider First Line Business Practice Location Address:
562 WYOMING 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:
18704-3721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-552-7500
Provider Business Practice Location Address Fax Number:
570-552-7520
Provider Enumeration Date:
01/15/2021