Provider First Line Business Practice Location Address:
241 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOSSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16912-1125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-638-2183
Provider Business Practice Location Address Fax Number:
570-638-3099
Provider Enumeration Date:
06/04/2006