Provider First Line Business Practice Location Address:
315 LOCUST ST
Provider Second Line Business Practice Location Address:
SUITE 5B
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15901-1651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-535-2030
Provider Business Practice Location Address Fax Number:
814-535-2031
Provider Enumeration Date:
09/06/2005