Provider First Line Business Practice Location Address:
110 FRANKLIN ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15901-1829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-536-5388
Provider Business Practice Location Address Fax Number:
814-536-6867
Provider Enumeration Date:
03/16/2007