Provider First Line Business Practice Location Address:
1045 N SAINT LUCAS ST
Provider Second Line Business Practice Location Address:
APT C
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104-3757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-332-0546
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/06/2008