Provider First Line Business Practice Location Address:
5521 HOLIDAY DR
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:
18104-9463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-360-5056
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/02/2026