Provider First Line Business Practice Location Address:
1250 S CEDAR CREST BLVD
Provider Second Line Business Practice Location Address:
SUITE 4-5
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18103-6224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-402-8420
Provider Business Practice Location Address Fax Number:
610-402-1689
Provider Enumeration Date:
03/26/2011