Provider First Line Business Practice Location Address:
240 MALL BLVD
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:
17815-8389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-416-5435
Provider Business Practice Location Address Fax Number:
570-416-5436
Provider Enumeration Date:
06/20/2005