Provider First Line Business Practice Location Address:
363 S ROUTE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18106-9212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-518-6814
Provider Business Practice Location Address Fax Number:
609-267-3499
Provider Enumeration Date:
10/24/2011