Provider First Line Business Practice Location Address:
65 EAST ELIZABETH AVENUE
Provider Second Line Business Practice Location Address:
SUITE 117
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18018-6506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-865-1799
Provider Business Practice Location Address Fax Number:
610-865-1799
Provider Enumeration Date:
10/03/2006