Provider First Line Business Practice Location Address:
1924 OLD BERWICK RD
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:
17815-3036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-784-2811
Provider Business Practice Location Address Fax Number:
570-784-2822
Provider Enumeration Date:
03/30/2011