Provider First Line Business Practice Location Address:
200 PROSPECT ST
Provider Second Line Business Practice Location Address:
HAWTHRONE SUITES ROOM 153
Provider Business Practice Location Address City Name:
EAST STROUDSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-800-1699
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2019