Provider First Line Business Practice Location Address:
833 COLUMBIA BLVD
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:
17815-2325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-784-8061
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/21/2025