Provider First Line Business Practice Location Address:
3722 WILLIAM PENN AVE
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:
15909-4237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-840-6015
Provider Business Practice Location Address Fax Number:
814-749-0869
Provider Enumeration Date:
03/30/2012