Provider First Line Business Practice Location Address:
1612 NORMA 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:
16801-6228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-867-3842
Provider Business Practice Location Address Fax Number:
814-231-0795
Provider Enumeration Date:
12/13/2006