Provider First Line Business Practice Location Address:
400 N 17TH 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:
18104-5052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-484-2284
Provider Business Practice Location Address Fax Number:
910-484-1673
Provider Enumeration Date:
06/12/2013