Provider First Line Business Practice Location Address:
2188 SANDY DR.
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-278-1977
Provider Business Practice Location Address Fax Number:
814-272-0070
Provider Enumeration Date:
01/08/2006