Provider First Line Business Practice Location Address:
3601 COUNTRY CLUB RD
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:
18103-6984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-737-5702
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2011