Provider First Line Business Practice Location Address:
208 S ALLEN 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:
16801-4805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-238-7281
Provider Business Practice Location Address Fax Number:
814-234-5671
Provider Enumeration Date:
09/17/2006