Provider First Line Business Practice Location Address:
307 VINE 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:
15901-2906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-288-4961
Provider Business Practice Location Address Fax Number:
814-809-8479
Provider Enumeration Date:
02/17/2015