Provider First Line Business Practice Location Address:
5749 LOWER MACUNGIE ROAD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
EAST TEXAS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18046-0011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-477-5624
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2011