Provider First Line Business Practice Location Address:
2139 W ALLEN ST
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:
18104-4369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-664-6706
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2021