Provider First Line Business Practice Location Address:
500 E MARYLYN 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:
16801-6269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-238-3322
Provider Business Practice Location Address Fax Number:
814-238-2920
Provider Enumeration Date:
08/09/2006