Provider First Line Business Practice Location Address:
134 BROAD ST
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
STROUDSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18360-1590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-421-7868
Provider Business Practice Location Address Fax Number:
570-421-7820
Provider Enumeration Date:
11/13/2006