Provider First Line Business Practice Location Address:
RR 5 BOX 5289
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:
18301-9164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-223-0826
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2006