Provider First Line Business Practice Location Address:
2160 SANDY DR STE A
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:
16803-2282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-861-8122
Provider Business Practice Location Address Fax Number:
814-861-4292
Provider Enumeration Date:
04/22/2013