Provider First Line Business Practice Location Address:
227 S BURROWES 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:
16801-4010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-238-3553
Provider Business Practice Location Address Fax Number:
814-238-6918
Provider Enumeration Date:
02/15/2007