Provider First Line Business Practice Location Address:
500 CHENEY OAKS DRIVE
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:
15905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-255-2213
Provider Business Practice Location Address Fax Number:
814-255-2777
Provider Enumeration Date:
10/01/2007