Provider First Line Business Practice Location Address:
1850 E PARK AVE STE 112
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:
16803-6706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-865-3566
Provider Business Practice Location Address Fax Number:
814-863-7803
Provider Enumeration Date:
06/22/2010