Provider First Line Business Practice Location Address:
322 WARREN ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15905-3443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-288-1418
Provider Business Practice Location Address Fax Number:
814-288-5427
Provider Enumeration Date:
07/12/2006