Provider First Line Business Practice Location Address:
119 S FRASER ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-3886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-470-2859
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2010