Provider First Line Business Practice Location Address:
RT 611
Provider Second Line Business Practice Location Address:
STROUD BLDG SUITE 100-C
Provider Business Practice Location Address City Name:
STROUDSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-420-8811
Provider Business Practice Location Address Fax Number:
570-420-8509
Provider Enumeration Date:
08/21/2006