Provider First Line Business Practice Location Address:
702 SAWMILL RD
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
BLOOMSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17815-7727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-784-9272
Provider Business Practice Location Address Fax Number:
570-784-3678
Provider Enumeration Date:
02/01/2006