Provider First Line Business Practice Location Address:
211 E 1ST 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:
17815-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-506-1115
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2023