Provider First Line Business Practice Location Address:
2134 SANDY DR STE 16
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:
16803-2292
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-272-5805
Provider Business Practice Location Address Fax Number:
814-272-0110
Provider Enumeration Date:
08/28/2012