Provider First Line Business Practice Location Address:
1402 S. ATHERTON ST. SUITE 105
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:
16801-7641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-862-9122
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2007