Provider First Line Business Practice Location Address:
2317 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:
18612-9245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-675-1190
Provider Business Practice Location Address Fax Number:
570-675-5885
Provider Enumeration Date:
01/10/2007