Provider First Line Business Practice Location Address:
315 S ALLEN ST SUITE 124B
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:
16801-4849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-272-1300
Provider Business Practice Location Address Fax Number:
814-954-4861
Provider Enumeration Date:
09/15/2010