Provider First Line Business Practice Location Address:
2125 28TH ST SW
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18103-7380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-782-9101
Provider Business Practice Location Address Fax Number:
610-782-0967
Provider Enumeration Date:
07/11/2006