Provider First Line Business Practice Location Address:
135 COUNTY HIGHWAY 128
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12095-3823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
151-876-2020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2007