Provider First Line Business Practice Location Address:
1 KIM AVE STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUNKHANNOCK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18657-9101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-836-6333
Provider Business Practice Location Address Fax Number:
570-836-5214
Provider Enumeration Date:
07/30/2006