Provider First Line Business Practice Location Address:
2201 5TH STREET HOLLOW ROAD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
BLOOMSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-387-0236
Provider Business Practice Location Address Fax Number:
570-784-1942
Provider Enumeration Date:
07/19/2006