Provider First Line Business Practice Location Address:
1700 OLD GATESBURG RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16803-2276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-237-3360
Provider Business Practice Location Address Fax Number:
814-237-2130
Provider Enumeration Date:
07/22/2005