Provider First Line Business Practice Location Address:
5 CHURCH ST
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:
18612-1155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-675-1076
Provider Business Practice Location Address Fax Number:
570-674-8919
Provider Enumeration Date:
11/30/2020