Provider First Line Business Practice Location Address:
1000 MARKET ST
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:
17815-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-784-2282
Provider Business Practice Location Address Fax Number:
570-784-2332
Provider Enumeration Date:
09/08/2016