Provider First Line Business Practice Location Address:
100 COLLEGE DR
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:
18104-6196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-899-7674
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2022