Provider First Line Business Practice Location Address:
143 HOSPITAL DR STE 105
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:
16803-5500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-231-7100
Provider Business Practice Location Address Fax Number:
814-231-7098
Provider Enumeration Date:
05/14/2026