Provider First Line Business Practice Location Address:
133 TIRE HILL RD
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15905-7205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-288-1800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2006