Provider First Line Business Practice Location Address:
2214 N ATHERTON ST
Provider Second Line Business Practice Location Address:
#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:
16803-1544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-235-4932
Provider Business Practice Location Address Fax Number:
814-272-7800
Provider Enumeration Date:
04/02/2014