Provider First Line Business Practice Location Address:
214 CENTER 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:
17815-1752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-336-9921
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/19/2012