Provider First Line Business Practice Location Address:
190 WELLES STREET
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:
18704-4968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-718-4140
Provider Business Practice Location Address Fax Number:
570-718-4141
Provider Enumeration Date:
08/02/2022