Provider First Line Business Practice Location Address:
2603 E COLLEGE AVE STE B
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:
16801-7542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-235-2266
Provider Business Practice Location Address Fax Number:
814-235-1715
Provider Enumeration Date:
01/06/2009