Provider First Line Business Practice Location Address:
1000 MARKET ST
Provider Second Line Business Practice Location Address:
SUITE 35
Provider Business Practice Location Address City Name:
BLOOMSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17815-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-389-1607
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2006