Provider First Line Business Practice Location Address:
612 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18018-4301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-865-3151
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2026