Provider First Line Business Practice Location Address:
128 FAIRGROUND CIR APT 502
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STROUDSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18360-1273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-921-9526
Provider Business Practice Location Address Fax Number:
570-921-9526
Provider Enumeration Date:
03/12/2026