Provider First Line Business Practice Location Address:
550 MEMORIAL HWY
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18612-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-675-7955
Provider Business Practice Location Address Fax Number:
570-675-7882
Provider Enumeration Date:
08/16/2005