Provider First Line Business Practice Location Address:
142 GAZEBO PARK
Provider Second Line Business Practice Location Address:
THIRD FLOOR, SUITE 307
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15901-1810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-659-4629
Provider Business Practice Location Address Fax Number:
814-539-8440
Provider Enumeration Date:
01/18/2007