Provider First Line Business Practice Location Address:
17TH & CHEW STREET
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:
18105-7017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-969-3390
Provider Business Practice Location Address Fax Number:
610-969-3393
Provider Enumeration Date:
10/17/2005