Provider First Line Business Practice Location Address:
401 N 17TH ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104-5034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-821-8033
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2006