Provider First Line Business Practice Location Address:
2200 W HAMILTON ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104-6337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-435-4535
Provider Business Practice Location Address Fax Number:
610-435-4599
Provider Enumeration Date:
07/19/2005