Provider First Line Business Practice Location Address:
65 COUNTRY CLUB SHOPPING CTR
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:
18612-1235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-675-8888
Provider Business Practice Location Address Fax Number:
570-675-8375
Provider Enumeration Date:
07/06/2006