Provider First Line Business Practice Location Address:
212 WEST MAIN STREET
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:
17815-1865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-764-1610
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2008