Provider First Line Business Practice Location Address:
457 RIDGE 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:
17815-3371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-441-4623
Provider Business Practice Location Address Fax Number:
570-356-2207
Provider Enumeration Date:
05/22/2007