Provider First Line Business Practice Location Address:
3168 MEMORIAL HWY
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18612-9201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-675-3627
Provider Business Practice Location Address Fax Number:
570-675-7320
Provider Enumeration Date:
08/13/2006