Provider First Line Business Practice Location Address:
1450 SCALP AVE STE 106
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:
15904-3340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-266-8466
Provider Business Practice Location Address Fax Number:
724-527-9370
Provider Enumeration Date:
06/02/2006