Provider First Line Business Practice Location Address:
214 N COMRIE AVE
Provider Second Line Business Practice Location Address:
JOHNSTOWN MALL
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12095-1502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-762-9262
Provider Business Practice Location Address Fax Number:
518-762-4402
Provider Enumeration Date:
07/21/2006