Provider First Line Business Practice Location Address:
1315 S. ALLEN ST.
Provider Second Line Business Practice Location Address:
SUITE 303
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-571-3136
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2007