Provider First Line Business Practice Location Address:
315 SUSQUEHANNA 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:
15905-1852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-525-8496
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2023