Provider First Line Business Practice Location Address: 
437 MAIN 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: 
18360-2597
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
570-421-1110
    Provider Business Practice Location Address Fax Number: 
570-421-1207
    Provider Enumeration Date: 
06/13/2005