Provider First Line Business Practice Location Address:
147D RECREATION HALL
Provider Second Line Business Practice Location Address:
PENNSYLVANIA STATE UNIVERSITY
Provider Business Practice Location Address City Name:
UNIVERSITY PARK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-867-0476
Provider Business Practice Location Address Fax Number:
814-865-1746
Provider Enumeration Date:
02/14/2007