Provider First Line Business Practice Location Address:
1086 FRANKLIN ST
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:
15905-4305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-534-3745
Provider Business Practice Location Address Fax Number:
814-534-5677
Provider Enumeration Date:
04/23/2009