Provider First Line Business Practice Location Address:
1850 EAST PARK AVENUE, SUITE 207
Provider Second Line Business Practice Location Address:
PENN STATE HEALTH AT MOUNT NITTANY MEDICAL CENTER
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-235-2480
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2017