Provider First Line Business Practice Location Address:
233 EASTERLY PKWY
Provider Second Line Business Practice Location Address:
STE 106
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-6300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-238-8119
Provider Business Practice Location Address Fax Number:
814-238-8119
Provider Enumeration Date:
09/27/2006