Provider First Line Business Practice Location Address:
2437 COMMERCIAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-7454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-237-7400
Provider Business Practice Location Address Fax Number:
814-237-2900
Provider Enumeration Date:
10/05/2005