Provider First Line Business Practice Location Address:
134 BROAD ST
Provider Second Line Business Practice Location Address:
SUITE 5
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:
570-872-9324
Provider Business Practice Location Address Fax Number:
570-872-9325
Provider Enumeration Date:
11/12/2007