Provider First Line Business Practice Location Address:
676 REAR WYOMING AVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-331-0824
Provider Business Practice Location Address Fax Number:
570-331-0827
Provider Enumeration Date:
07/28/2006