Provider First Line Business Practice Location Address:
315 S ALLEN ST
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-4849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-237-2204
Provider Business Practice Location Address Fax Number:
814-237-9611
Provider Enumeration Date:
07/22/2009