Provider First Line Business Practice Location Address:
226 FAIRFIELD AVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-535-6167
Provider Business Practice Location Address Fax Number:
814-535-5428
Provider Enumeration Date:
02/07/2007