Provider First Line Business Practice Location Address:
2607 OLD BERWICK RD
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:
17815-3238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-784-2529
Provider Business Practice Location Address Fax Number:
570-784-1001
Provider Enumeration Date:
11/19/2006