Provider First Line Business Practice Location Address:
423 3RD AVE STE B
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:
18704-5809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-288-3601
Provider Business Practice Location Address Fax Number:
570-288-1726
Provider Enumeration Date:
02/28/2006