Provider First Line Business Practice Location Address:
222 HUNTER 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:
16801-6947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-237-1450
Provider Business Practice Location Address Fax Number:
814-234-2686
Provider Enumeration Date:
08/22/2007