Provider First Line Business Practice Location Address:
354 N 9TH ST
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:
18360-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-963-1279
Provider Business Practice Location Address Fax Number:
800-918-8230
Provider Enumeration Date:
09/30/2021