Provider First Line Business Practice Location Address:
336 BLOOMFIELD ST STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15904-3271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-266-5650
Provider Business Practice Location Address Fax Number:
814-266-5653
Provider Enumeration Date:
06/13/2005