Provider First Line Business Practice Location Address:
2147 E COLLEGE AVE STE A
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:
16801-7204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-867-2828
Provider Business Practice Location Address Fax Number:
814-867-2828
Provider Enumeration Date:
04/12/2021