Provider First Line Business Practice Location Address:
227 CENTER 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:
17815-1701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-204-6358
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2007