Provider First Line Business Practice Location Address:
114 LT MICHAEL CLEARY DR
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:
18612-1649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-675-2000
Provider Business Practice Location Address Fax Number:
570-675-1806
Provider Enumeration Date:
12/07/2006