Provider First Line Business Practice Location Address:
374 THEATRE DR STE 2A
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:
15904-3221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-535-6521
Provider Business Practice Location Address Fax Number:
814-536-4819
Provider Enumeration Date:
01/30/2007