Provider First Line Business Practice Location Address:
501 N 17TH ST
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104-5044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-432-9593
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2007