Provider First Line Business Practice Location Address:
2581 CLYDE AVE
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:
16801-7508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-943-8164
Provider Business Practice Location Address Fax Number:
814-940-7864
Provider Enumeration Date:
03/23/2008