Provider First Line Business Practice Location Address:
213 LUTHER RD
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:
15904-2714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-266-9656
Provider Business Practice Location Address Fax Number:
814-266-3292
Provider Enumeration Date:
04/19/2007