Provider First Line Business Practice Location Address:
571 WYOMING 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:
18704-3719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-283-2000
Provider Business Practice Location Address Fax Number:
570-287-0525
Provider Enumeration Date:
09/29/2006