Provider First Line Business Practice Location Address:
315 S ALLEN ST
Provider Second Line Business Practice Location Address:
SUITE 218
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-4849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-234-3010
Provider Business Practice Location Address Fax Number:
814-234-2170
Provider Enumeration Date:
09/28/2006