Provider First Line Business Practice Location Address:
119 S BURROWES ST
Provider Second Line Business Practice Location Address:
SUITE 607
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-3867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-861-2400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2008