Provider First Line Business Practice Location Address: 
1251 S CEDAR CREST BLVD
    Provider Second Line Business Practice Location Address: 
SUITE 207C
    Provider Business Practice Location Address City Name: 
ALLENTOWN
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
18103-6205
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
610-437-9000
    Provider Business Practice Location Address Fax Number: 
610-437-6298
    Provider Enumeration Date: 
01/29/2008