Provider First Line Business Practice Location Address:
1346 S ATHERTON ST
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:
16801-6203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-380-9060
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2007