Provider First Line Business Practice Location Address:
926 N CEDAR CREST BLVD APT B926
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104-3411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
385-313-4170
Provider Business Practice Location Address Fax Number:
801-303-6556
Provider Enumeration Date:
10/13/2006