Provider First Line Business Practice Location Address:
237 JOHNS ST
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:
15901-1555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-539-2050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2012