Provider First Line Business Practice Location Address:
1800 E PARK 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:
16803-6709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-278-4818
Provider Business Practice Location Address Fax Number:
814-234-6150
Provider Enumeration Date:
01/31/2007