Provider First Line Business Practice Location Address:
1460 MARTIN ST
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:
16803-3065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-238-8540
Provider Business Practice Location Address Fax Number:
814-238-8638
Provider Enumeration Date:
10/03/2012