Provider First Line Business Practice Location Address:
1300 BENNER PIKE
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-7325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-867-1970
Provider Business Practice Location Address Fax Number:
814-867-1973
Provider Enumeration Date:
08/09/2006