Provider First Line Business Practice Location Address:
2447 BEDFORD ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15904-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-254-4247
Provider Business Practice Location Address Fax Number:
814-534-4454
Provider Enumeration Date:
11/02/2010