Provider First Line Business Practice Location Address:
40 DALLAS SHOPPING CTR
Provider Second Line Business Practice Location Address:
ROUTE 309
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18612-1231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-675-0874
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2006