Provider First Line Business Practice Location Address: 
101 N 6TH ST STE 310
    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: 
18101-1403
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
484-224-0777
    Provider Business Practice Location Address Fax Number: 
610-969-2432
    Provider Enumeration Date: 
04/29/2022