Provider First Line Business Practice Location Address:
605 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-496-5717
Provider Business Practice Location Address Fax Number:
724-368-3006
Provider Enumeration Date:
07/11/2006