Provider First Line Business Practice Location Address:
136 JAYCEE DR
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15904-3650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-467-4055
Provider Business Practice Location Address Fax Number:
814-262-8161
Provider Enumeration Date:
04/23/2013