Provider First Line Business Practice Location Address:
140 RECREATION BLDG
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIVERSITY PARK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16802-5700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
857-265-8333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2020