Provider First Line Business Practice Location Address:
RR 3 BOX 3302B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STROUDSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18360-9346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-629-4921
Provider Business Practice Location Address Fax Number:
570-629-9221
Provider Enumeration Date:
02/15/2007