Provider First Line Business Practice Location Address:
520 RUAH STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-638-1260
Provider Business Practice Location Address Fax Number:
570-638-2065
Provider Enumeration Date:
11/28/2006