Provider First Line Business Practice Location Address:
2455 BLACK RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18015-5207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-997-7120
Provider Business Practice Location Address Fax Number:
610-997-7107
Provider Enumeration Date:
11/08/2006