Provider First Line Business Practice Location Address:
1736 LYTER DRIVE
Provider Second Line Business Practice Location Address:
WESTMONT SHOPPING CENTER
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15905-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-255-6831
Provider Business Practice Location Address Fax Number:
814-254-1521
Provider Enumeration Date:
05/01/2007