Provider First Line Business Practice Location Address:
214 COLLEGE PARK PLZ
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:
15904-2833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-262-0025
Provider Business Practice Location Address Fax Number:
814-266-8745
Provider Enumeration Date:
07/17/2006