Provider First Line Business Practice Location Address:
2590 PARK CENTER BLVD
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:
16801-3005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-231-7668
Provider Business Practice Location Address Fax Number:
814-231-7665
Provider Enumeration Date:
10/25/2005