Provider First Line Business Practice Location Address:
905 MENOHER BLVD
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:
15905-2834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-535-2504
Provider Business Practice Location Address Fax Number:
814-539-2948
Provider Enumeration Date:
06/27/2005