Provider First Line Business Practice Location Address:
5620 E. TEXAS RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST TEXAS (MACUNGIE)
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-398-9773
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2017