Provider First Line Business Practice Location Address:
426 PARK AVE
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:
15902-2511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-254-4868
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2006