Provider First Line Business Practice Location Address:
3832 YALICK PLAZA ROUTE 415
Provider Second Line Business Practice Location Address:
UNIT 7
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18612-7753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-213-5221
Provider Business Practice Location Address Fax Number:
570-227-3316
Provider Enumeration Date:
11/08/2017