Provider First Line Business Practice Location Address:
2411 COLUMBIA BOULEVARD
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:
17815-3135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-387-1900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2006