Provider First Line Business Practice Location Address:
1020 FRANKLIN ST
Provider Second Line Business Practice Location Address:
GS1252
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15905-4109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-534-1624
Provider Business Practice Location Address Fax Number:
814-534-1635
Provider Enumeration Date:
08/13/2009