Provider First Line Business Practice Location Address:
315 S ALLEN ST
Provider Second Line Business Practice Location Address:
STE 218
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-4850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-865-2191
Provider Business Practice Location Address Fax Number:
814-863-1331
Provider Enumeration Date:
07/11/2006