Provider First Line Business Practice Location Address:
647 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15901-2140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-535-5244
Provider Business Practice Location Address Fax Number:
814-536-2474
Provider Enumeration Date:
10/06/2006