Provider First Line Business Practice Location Address:
16 ROSE STREET
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:
15905-4327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-539-0257
Provider Business Practice Location Address Fax Number:
814-536-0963
Provider Enumeration Date:
06/04/2009