Provider First Line Business Practice Location Address:
519 PARK 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:
17815-2328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-784-0360
Provider Business Practice Location Address Fax Number:
570-784-0804
Provider Enumeration Date:
08/25/2006