Provider First Line Business Practice Location Address:
1257 COLUMBIA 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:
17815-8859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-380-1333
Provider Business Practice Location Address Fax Number:
570-380-1331
Provider Enumeration Date:
01/09/2009