Provider First Line Business Practice Location Address:
803 N WAHNETA ST
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:
18109-2422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-782-8361
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2021