Provider First Line Business Practice Location Address:
525 REAR 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:
18704-3602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-714-2166
Provider Business Practice Location Address Fax Number:
570-714-2177
Provider Enumeration Date:
07/05/2006