Provider First Line Business Practice Location Address:
111A ROOSEVELT BLOUEVARD
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:
15901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-619-4223
Provider Business Practice Location Address Fax Number:
814-539-0985
Provider Enumeration Date:
06/28/2005