Provider First Line Business Practice Location Address:
208 LIFELINE RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
STROUDSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18360-6419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-213-5794
Provider Business Practice Location Address Fax Number:
570-872-9344
Provider Enumeration Date:
09/18/2012