Provider First Line Business Practice Location Address:
550 THIRD AVE.
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704-5806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-283-2800
Provider Business Practice Location Address Fax Number:
570-283-3381
Provider Enumeration Date:
08/07/2006