Provider First Line Business Practice Location Address:
281 NORTH 12TH STREET, SUITE B
Provider Second Line Business Practice Location Address:
GNADEN HUETTEN PROFESSIONAL BUILDING
Provider Business Practice Location Address City Name:
LEHIGHTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-377-7793
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2009