Provider First Line Business Practice Location Address:
636 SCALP 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:
15904-1640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-262-0007
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/04/2021