Provider First Line Business Practice Location Address:
1 ACADEMIC 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:
15904-2946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-535-2277
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2017