Provider First Line Business Practice Location Address:
18 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08501-1610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-409-5519
Provider Business Practice Location Address Fax Number:
609-259-7592
Provider Enumeration Date:
11/21/2017