Provider First Line Business Practice Location Address:
1493 WETHERSFIELD DR
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:
18104-1945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-391-1178
Provider Business Practice Location Address Fax Number:
610-391-9122
Provider Enumeration Date:
08/24/2005