Provider First Line Business Practice Location Address:
132 S LEA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACUNGIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18062-1216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-441-9057
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2012