Provider First Line Business Practice Location Address:
636 REAR SCALP AVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-536-7313
Provider Business Practice Location Address Fax Number:
814-535-2177
Provider Enumeration Date:
03/19/2007