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120 Radnor Rd State College PA 16801-7970 | |
| (814) 231-7868 | |
| (814) 238-4169 |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 120 Radnor Rd, State College, Pennsylvania |
| Authorized Official Name and Position | Bryan Roach (CFO) |
| Authorized Official Contact | 8142346148 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1800 E Park Ave State College PA 16803-6701 Ph: (814) 231-7000 | 120 Radnor Rd State College PA 16801-7970 Ph: (814) 231-7868 |
| NPI Number | 1245418334 |
|---|---|
| Provider Enumeration Date | 01/31/2008 |
| Last Update Date | 10/04/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245418334 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (Pennsylvania) | Primary |
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