Provider First Line Business Practice Location Address: 
1245 S CEDAR CREST BLVD STE 303
    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: 
18103-6258
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
610-435-4151
    Provider Business Practice Location Address Fax Number: 
610-435-3044
    Provider Enumeration Date: 
03/15/2018