Provider First Line Business Practice Location Address:
1315 S ALLEN ST
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-5923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-235-1035
Provider Business Practice Location Address Fax Number:
814-235-1037
Provider Enumeration Date:
03/27/2008