Provider First Line Business Practice Location Address:
1086 FRANKLIN STREET,
Provider Second Line Business Practice Location Address:
GOOD SAMARITAN BLDG, GROUND FLOOR
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:
814-539-8725
Provider Business Practice Location Address Fax Number:
814-539-6336
Provider Enumeration Date:
07/06/2006