Provider First Line Business Practice Location Address:
146 J RECREATION BLDG
Provider Second Line Business Practice Location Address:
THE PENNSYLVANIA STATE UNIVERSITY
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-865-2725
Provider Business Practice Location Address Fax Number:
814-865-1151
Provider Enumeration Date:
02/07/2006