Provider First Line Business Practice Location Address:
298 E 5TH 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:
17815-2353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-317-2999
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2014