Provider First Line Business Practice Location Address:
3151 COLUMBIA BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BLOOMSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17815-8889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-784-0500
Provider Business Practice Location Address Fax Number:
570-784-9563
Provider Enumeration Date:
02/23/2007