Provider First Line Business Practice Location Address:
260 STRAYER ST
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:
15906-2037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-535-2868
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2006