Provider First Line Business Practice Location Address:
143 HOSPITAL DR STE 207
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:
814-235-2480
Provider Business Practice Location Address Fax Number:
814-235-2482
Provider Enumeration Date:
04/07/2026