Provider First Line Business Practice Location Address:
91 RAILROAD LN STE 101
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:
17815-7458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-316-1899
Provider Business Practice Location Address Fax Number:
570-243-0228
Provider Enumeration Date:
12/20/2012