Provider First Line Business Practice Location Address:
101 S 17TH ST
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:
18104-6704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-821-9228
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/26/2005