Provider First Line Business Practice Location Address:
1141 RIDGE ROAD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-784-1526
Provider Business Practice Location Address Fax Number:
570-784-1573
Provider Enumeration Date:
10/10/2006