Provider First Line Business Practice Location Address:
1125 S CEDAR CREST BLVD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18103-7903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-550-7636
Provider Business Practice Location Address Fax Number:
800-734-6065
Provider Enumeration Date:
05/08/2015