Provider First Line Business Practice Location Address:
119 WALNUT ST STE 500
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:
15901-1652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-792-3855
Provider Business Practice Location Address Fax Number:
814-539-6243
Provider Enumeration Date:
01/13/2014