Provider First Line Business Practice Location Address:
114 JAMES 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:
15902-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
582-855-0908
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2026