Provider First Line Business Practice Location Address:
1739 W FAIRMONT 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:
18104-3117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-437-4988
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2014