Provider First Line Business Practice Location Address:
5879 SR 92
Provider Second Line Business Practice Location Address:
SUITE 3 LENOX PLAZA
Provider Business Practice Location Address City Name:
KINGSLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18826-9751
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:
570-222-5006
Provider Enumeration Date:
09/26/2005