Provider First Line Business Practice Location Address:
313 LOGAN 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:
16801-4623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-206-9944
Provider Business Practice Location Address Fax Number:
224-235-4652
Provider Enumeration Date:
06/22/2007