Provider First Line Business Practice Location Address:
131 ALMA MATER CT APT A
Provider Second Line Business Practice Location Address:
STATE COLLEGE
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16803-1864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-953-4437
Provider Business Practice Location Address Fax Number:
814-867-1001
Provider Enumeration Date:
02/23/2007