Provider First Line Business Practice Location Address:
2867 W SOUTH 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:
18103-2829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-634-1820
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2025