Provider First Line Business Practice Location Address:
700 S. PERRY ST.
Provider Second Line Business Practice Location Address:
ST. MARY'S HOSPITAL FAM HLTH CNTR AT JOHNSTOWN PEDIATRI
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-762-3161
Provider Business Practice Location Address Fax Number:
518-762-6751
Provider Enumeration Date:
12/12/2005