Provider First Line Business Practice Location Address:
1860 SASSAFRASS LN
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:
18103-9239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-445-7231
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2025