Provider First Line Business Practice Location Address:
2025 W CEDAR ST
Provider Second Line Business Practice Location Address:
APT. C
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104-4065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-841-2789
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2012