Provider First Line Business Practice Location Address:
115 W 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18015-1605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-867-3701
Provider Business Practice Location Address Fax Number:
610-866-1499
Provider Enumeration Date:
09/16/2005