Provider First Line Business Practice Location Address:
12 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08501-1607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-213-6055
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2022