Provider First Line Business Practice Location Address:
2901 E COLLEGE AVE
Provider Second Line Business Practice Location Address:
SUITE 976
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-7577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-234-3047
Provider Business Practice Location Address Fax Number:
814-238-0898
Provider Enumeration Date:
10/19/2005