Provider First Line Business Practice Location Address:
732 N 19TH 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:
18104-4041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-432-4373
Provider Business Practice Location Address Fax Number:
610-432-4374
Provider Enumeration Date:
11/07/2007