Provider First Line Business Practice Location Address:
201 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:
18612-1240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-675-8151
Provider Business Practice Location Address Fax Number:
570-675-7524
Provider Enumeration Date:
04/16/2007