Provider First Line Business Practice Location Address:
2311 W LIBERTY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104-4944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
929-228-5073
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2026