Provider First Line Business Practice Location Address:
403 S ALLEN ST
Provider Second Line Business Practice Location Address:
SUITE 209-A
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-5252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-231-7700
Provider Business Practice Location Address Fax Number:
814-231-7778
Provider Enumeration Date:
03/22/2007