Provider First Line Business Practice Location Address:
4608 BROADWAY UNIT C
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:
18104-3202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-432-4155
Provider Business Practice Location Address Fax Number:
610-432-9542
Provider Enumeration Date:
09/13/2016