Provider First Line Business Practice Location Address:
420 SHAFFER 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:
17815-8929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-387-6868
Provider Business Practice Location Address Fax Number:
570-387-6844
Provider Enumeration Date:
11/18/2009