Provider First Line Business Practice Location Address:
4684 BROADWAY
Provider Second Line Business Practice Location Address:
TILGHMAN SQUARE
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104-3214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-391-0858
Provider Business Practice Location Address Fax Number:
610-391-0528
Provider Enumeration Date:
06/04/2006