Provider First Line Business Practice Location Address:
1172 MEMORIAL HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18612-9178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-675-4775
Provider Business Practice Location Address Fax Number:
570-675-8552
Provider Enumeration Date:
11/15/2006