Provider First Line Business Practice Location Address:
1605 N CEDAR CREST BLVD
Provider Second Line Business Practice Location Address:
SUITE 609
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104-2351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-433-7717
Provider Business Practice Location Address Fax Number:
610-433-5660
Provider Enumeration Date:
11/14/2005