Provider First Line Business Practice Location Address:
3101 EMRICK BLVD
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18020-8037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-419-6482
Provider Business Practice Location Address Fax Number:
610-419-6483
Provider Enumeration Date:
12/27/2007