Provider First Line Business Practice Location Address:
507 TIRE HILL ROAD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-254-4410
Provider Business Practice Location Address Fax Number:
814-254-4348
Provider Enumeration Date:
09/18/2013