Provider First Line Business Practice Location Address:
5520 COVENANT CT
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:
18106-8726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-956-7798
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2012