Provider First Line Business Practice Location Address:
812 CENTRAL ROAD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-784-4321
Provider Business Practice Location Address Fax Number:
570-784-4490
Provider Enumeration Date:
11/20/2006