Provider First Line Business Practice Location Address:
1220 ILLICKS MILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18017-3654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-865-8155
Provider Business Practice Location Address Fax Number:
610-758-8998
Provider Enumeration Date:
03/17/2006