Provider First Line Business Practice Location Address:
2166 S 12TH 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:
18103-8701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-969-0488
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/05/2006