Provider First Line Business Practice Location Address:
1318 N 5TH ST
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-664-2455
Provider Business Practice Location Address Fax Number:
800-509-6099
Provider Enumeration Date:
03/28/2018