Provider First Line Business Practice Location Address:
1510 ELIZABETH RD
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:
16801-6931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-660-9647
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2026