Provider First Line Business Practice Location Address:
256 SCHUYLER AVENUE
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:
18704-3322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-283-5917
Provider Business Practice Location Address Fax Number:
570-763-0067
Provider Enumeration Date:
06/17/2005