Provider First Line Business Practice Location Address:
425 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:
17815-1480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-387-2474
Provider Business Practice Location Address Fax Number:
570-387-2397
Provider Enumeration Date:
06/04/2018