Provider First Line Business Practice Location Address:
205 E BEAVER AVE
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:
16801-4903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-237-1751
Provider Business Practice Location Address Fax Number:
814-237-6069
Provider Enumeration Date:
10/17/2006