Provider First Line Business Practice Location Address:
110 COAL 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:
15901-2311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-244-8414
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2011