Provider First Line Business Practice Location Address:
715 DECATUR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18017-4807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-781-2817
Provider Business Practice Location Address Fax Number:
484-781-2817
Provider Enumeration Date:
11/19/2025