Provider First Line Business Practice Location Address:
1123C 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:
17815-2913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-799-8927
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/21/2007