Provider First Line Business Practice Location Address:
353 MARKET ST
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15901-1711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-536-8935
Provider Business Practice Location Address Fax Number:
814-536-8936
Provider Enumeration Date:
06/20/2014