Provider First Line Business Practice Location Address:
106 S MADISON 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:
18102-4636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-542-1891
Provider Business Practice Location Address Fax Number:
208-439-1637
Provider Enumeration Date:
04/16/2014