Provider First Line Business Practice Location Address:
510 WAYNE ST
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:
15905-2338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-535-6312
Provider Business Practice Location Address Fax Number:
812-535-5136
Provider Enumeration Date:
04/22/2009