Provider First Line Business Practice Location Address: 
1200 S CEDAR CREST BLVD
    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: 
18103-6202
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
610-402-8000
    Provider Business Practice Location Address Fax Number: 
484-884-3197
    Provider Enumeration Date: 
10/26/2006