Provider First Line Business Practice Location Address:
215 LUTHER RD
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:
15904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-266-2595
Provider Business Practice Location Address Fax Number:
814-266-2595
Provider Enumeration Date:
10/30/2006