Provider First Line Business Practice Location Address:
805 S ATHERTON ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-4671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-278-1912
Provider Business Practice Location Address Fax Number:
814-278-1921
Provider Enumeration Date:
07/01/2010