Provider First Line Business Practice Location Address:
410 GLENN AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BLOOMSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17815-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-387-2135
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/04/2008