Provider First Line Business Practice Location Address:
205 APPLEGATE RD STE 1001133
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:
18360-6502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
155-433-4882
Provider Business Practice Location Address Fax Number:
215-543-3488
Provider Enumeration Date:
07/21/2006