Provider First Line Business Practice Location Address:
425 E 1ST ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
BLOOMSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17815-1480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-387-2060
Provider Business Practice Location Address Fax Number:
570-387-2316
Provider Enumeration Date:
03/21/2007