Provider First Line Business Practice Location Address:
519 ASH ST
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:
15902-2021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-536-5617
Provider Business Practice Location Address Fax Number:
814-536-5617
Provider Enumeration Date:
02/14/2013