Provider First Line Business Practice Location Address:
1600 HANOVER AVE
Provider Second Line Business Practice Location Address:
ALLENTOWN STATE HOSPITAL BUILDING 1
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18109-2498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-836-3131
Provider Business Practice Location Address Fax Number:
215-836-1802
Provider Enumeration Date:
10/25/2010