Provider First Line Business Practice Location Address:
450 WAUPELANI DRIVE
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:
16801-4516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-237-0630
Provider Business Practice Location Address Fax Number:
814-237-1803
Provider Enumeration Date:
04/11/2006