Provider First Line Business Practice Location Address:
225 COLUMBIA MALL DR
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:
17815-8368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-277-6565
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2006