Provider First Line Business Practice Location Address:
2123 E COLLEGE AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-7280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-235-9200
Provider Business Practice Location Address Fax Number:
814-235-9201
Provider Enumeration Date:
06/06/2011