Provider First Line Business Practice Location Address:
3369 STATE ROUTE 100
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:
18062-9613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-402-8111
Provider Business Practice Location Address Fax Number:
610-402-4546
Provider Enumeration Date:
12/30/2005