Provider First Line Business Practice Location Address:
1146 S CEDAR CREST BLVD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18103-7938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-774-0170
Provider Business Practice Location Address Fax Number:
610-774-0173
Provider Enumeration Date:
07/13/2006