Provider First Line Business Practice Location Address:
1107 WEST COLLEGE AVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-325-0280
Provider Business Practice Location Address Fax Number:
814-826-2241
Provider Enumeration Date:
08/27/2010