Provider First Line Business Practice Location Address:
1450 SCALP AVE
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15904-3321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-266-8466
Provider Business Practice Location Address Fax Number:
814-266-0177
Provider Enumeration Date:
08/25/2009