Provider First Line Business Practice Location Address:
143 HOSPITAL DR STE 103
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:
16803-5500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-234-6750
Provider Business Practice Location Address Fax Number:
814-231-7098
Provider Enumeration Date:
11/24/2006