Provider First Line Business Practice Location Address:
1251 S CEDAR CREST BLVD
Provider Second Line Business Practice Location Address:
SUITE 301 C
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18103-6205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-776-0211
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2005