Provider First Line Business Practice Location Address:
50 VINE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST STROUDSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18301-0298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-424-8500
Provider Business Practice Location Address Fax Number:
570-517-5967
Provider Enumeration Date:
04/16/2012