Provider First Line Business Practice Location Address:
6620 GRANT WAY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18106-9316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-437-8850
Provider Business Practice Location Address Fax Number:
610-437-8852
Provider Enumeration Date:
08/07/2006