Provider First Line Business Practice Location Address:
728 E 5TH ST
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:
17815-2305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-784-5000
Provider Business Practice Location Address Fax Number:
570-387-8832
Provider Enumeration Date:
09/01/2006