Provider First Line Business Practice Location Address:
1125 MAIN 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:
15909-2016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-535-5300
Provider Business Practice Location Address Fax Number:
724-234-4703
Provider Enumeration Date:
04/19/2006