Provider First Line Business Practice Location Address:
540 PIERCE 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:
18704-5751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-718-1772
Provider Business Practice Location Address Fax Number:
570-718-1775
Provider Enumeration Date:
09/07/2010