Provider First Line Business Practice Location Address:
549 FAIR 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:
17815-6107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-416-1867
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2006