Provider First Line Business Practice Location Address:
3932 LONGFELLOW ST
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:
18104-3335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-553-5853
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2025