Provider First Line Business Practice Location Address:
320 MAIN ST
Provider Second Line Business Practice Location Address:
4TH FLOOR
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15901-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-534-6991
Provider Business Practice Location Address Fax Number:
814-534-6994
Provider Enumeration Date:
06/13/2005