Provider First Line Business Practice Location Address:
102 N MARKET ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
BLOOMSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-387-1950
Provider Business Practice Location Address Fax Number:
570-925-2786
Provider Enumeration Date:
04/04/2006