Provider First Line Business Practice Location Address:
1627 CHEW ST FL 3
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:
18102-3648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-402-1155
Provider Business Practice Location Address Fax Number:
610-969-2786
Provider Enumeration Date:
12/13/2011