Provider First Line Business Practice Location Address:
611 UNIVERSITY DR STE 212
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:
16801-6552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-374-5171
Provider Business Practice Location Address Fax Number:
814-359-3193
Provider Enumeration Date:
09/17/2026