Provider First Line Business Practice Location Address:
1015 FRANKLIN ST
Provider Second Line Business Practice Location Address:
WESSEL BUILDING LEVEL D
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15905-4110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-534-5042
Provider Business Practice Location Address Fax Number:
814-534-5045
Provider Enumeration Date:
04/06/2011