Provider First Line Business Practice Location Address:
1000 SCOTT TOWN PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17815-2322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-389-9909
Provider Business Practice Location Address Fax Number:
570-389-0422
Provider Enumeration Date:
07/07/2006