Provider First Line Business Practice Location Address:
1728 W JONATHAN ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104-3170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-432-2706
Provider Business Practice Location Address Fax Number:
610-432-0775
Provider Enumeration Date:
03/30/2007