Provider First Line Business Practice Location Address:
903 OLD SCALP AVE
Provider Second Line Business Practice Location Address:
APT 275
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15904-1763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-255-9100
Provider Business Practice Location Address Fax Number:
814-255-9103
Provider Enumeration Date:
06/06/2006