Provider First Line Business Practice Location Address:
801 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:
15904-2554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-266-9505
Provider Business Practice Location Address Fax Number:
814-269-4705
Provider Enumeration Date:
07/13/2007