Provider First Line Business Practice Location Address:
1251 S CEDAR CREST BLVD
Provider Second Line Business Practice Location Address:
SUITE 212A
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18103-6205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-402-5301
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2006