Provider First Line Business Practice Location Address:
112 S FRASER ST
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:
16801-3849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-234-4383
Provider Business Practice Location Address Fax Number:
248-264-4383
Provider Enumeration Date:
02/28/2007