Provider First Line Business Practice Location Address:
550 MEMORIAL HWY
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:
18612-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-675-9540
Provider Business Practice Location Address Fax Number:
570-675-9540
Provider Enumeration Date:
08/04/2006