Provider First Line Business Practice Location Address: 
2649 SCHOENERSVILLE RD
    Provider Second Line Business Practice Location Address: 
SUITE 201
    Provider Business Practice Location Address City Name: 
BETHLEHEM
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
18017-7326
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
610-868-6880
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
05/10/2006