Provider First Line Business Practice Location Address:
425 EAST FIRST ST.,
Provider Second Line Business Practice Location Address:
STE. 201
Provider Business Practice Location Address City Name:
BLOOMSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17815-6080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-416-1816
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/18/2014