Graduated: 2022
NPI: 1528799004
Practice Locations (4)
PO BOX
LOS ANGELES, CA 90074
2100 MACK BLVD
ALLENTOWN, PA 181035622
2545 SCHOENERSVILLE RD
BETHLEHEM, PA 180177300
4100 INTERNATIONAL PLZ
FORT WORTH, TX 761094800
Source: CMS National Downloadable File, September 2026.