Provider First Line Business Practice Location Address:
4680 BROADWAY
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:
18104-3214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-351-2666
Provider Business Practice Location Address Fax Number:
610-351-2662
Provider Enumeration Date:
04/24/2018