Provider First Line Business Practice Location Address:
244 N PERRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12095-1212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-736-4079
Provider Business Practice Location Address Fax Number:
518-736-1520
Provider Enumeration Date:
03/06/2019