Provider First Line Business Practice Location Address:
125 PUDDINTOWN RD
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:
16801-6825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-237-8163
Provider Business Practice Location Address Fax Number:
814-231-8788
Provider Enumeration Date:
05/17/2006