Provider First Line Business Practice Location Address:
175 EAST BROWN STREET, SUITE 115
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST STROUDSBURG
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
18301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-420-9720
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/06/2006