Provider First Line Business Practice Location Address:
273 EAST ST
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:
17815-1844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-380-8980
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/10/2006