Provider First Line Business Practice Location Address:
1001 UNIVERSITY DR
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-6600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-234-4287
Provider Business Practice Location Address Fax Number:
814-234-3572
Provider Enumeration Date:
01/19/2006