Provider First Line Business Practice Location Address:
1425 SCALP AVE
Provider Second Line Business Practice Location Address:
SUITE 21
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15904-3328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-254-4727
Provider Business Practice Location Address Fax Number:
814-254-4729
Provider Enumeration Date:
12/21/2006