Provider First Line Business Practice Location Address:
1628 CHEW ST FL 3
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:
18102-3649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-969-2319
Provider Business Practice Location Address Fax Number:
610-702-1966
Provider Enumeration Date:
01/29/2021