Provider First Line Business Practice Location Address:
1315 S ALLEN ST STE 303
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:
16801-5923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-867-2866
Provider Business Practice Location Address Fax Number:
866-283-4558
Provider Enumeration Date:
05/27/2010