Provider First Line Business Practice Location Address:
1648 HAMILTON ST
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:
18102-5054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-628-8038
Provider Business Practice Location Address Fax Number:
866-736-5965
Provider Enumeration Date:
04/19/2007