Provider First Line Business Practice Location Address:
724 S ATHERTON ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-4628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-867-0717
Provider Business Practice Location Address Fax Number:
814-867-0464
Provider Enumeration Date:
05/22/2007