Provider First Line Business Practice Location Address:
STROUD BUILDING RT 611
Provider Second Line Business Practice Location Address:
STE 100C
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:
570-421-6112
Provider Business Practice Location Address Fax Number:
570-421-7066
Provider Enumeration Date:
05/24/2006