Provider First Line Business Practice Location Address:
1535 W CONGRESS 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:
18102-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-552-8041
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2026