Provider First Line Business Practice Location Address:
1850 E PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16803-6706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-234-8800
Provider Business Practice Location Address Fax Number:
814-235-1133
Provider Enumeration Date:
11/23/2005