Provider First Line Business Practice Location Address:
1405 N CEDAR CREST BLVD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104-2308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-395-2474
Provider Business Practice Location Address Fax Number:
610-351-2665
Provider Enumeration Date:
09/20/2005