Provider First Line Business Practice Location Address:
7400 ROUTE 611
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
STROUDSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18360-8384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-972-1408
Provider Business Practice Location Address Fax Number:
570-972-1407
Provider Enumeration Date:
01/31/2008