Provider First Line Business Practice Location Address:
103 E BEAVER AVE
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-4969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-861-2055
Provider Business Practice Location Address Fax Number:
814-861-2059
Provider Enumeration Date:
10/03/2006