Provider First Line Business Practice Location Address:
1200 S CEDAR CREST BLVD
Provider Second Line Business Practice Location Address:
BOX 689
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-402-9080
Provider Business Practice Location Address Fax Number:
610-402-9029
Provider Enumeration Date:
10/13/2005