Provider First Line Business Practice Location Address:
6620 GRANT WAY STE B
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:
18106-9316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-223-4940
Provider Business Practice Location Address Fax Number:
484-223-1049
Provider Enumeration Date:
06/12/2013