Provider First Line Business Practice Location Address:
611 UNIVERSITY DR STE 210
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-6552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-234-2007
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2006