Provider First Line Business Practice Location Address:
7740 RTE 611 STROUD COMMONS
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
STROUDSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18360-6501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-421-2332
Provider Business Practice Location Address Fax Number:
570-421-5632
Provider Enumeration Date:
06/12/2012