Provider First Line Business Practice Location Address: 
265 LEHIGH VALLEY MALL
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
WHITEHALL
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
18052-5719
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
610-266-6660
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
01/18/2007