Provider First Line Business Practice Location Address:
1551 W SOUTH ST APT 1
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:
18102-4553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-286-3801
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2018