Provider First Line Business Practice Location Address:
3604 S ATHERTON ST
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:
16801-8301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-466-8736
Provider Business Practice Location Address Fax Number:
814-466-6399
Provider Enumeration Date:
06/03/2006