Provider First Line Business Practice Location Address:
2691 WILLIAM PENN AVE APT 3
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:
15909-1036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-254-4499
Provider Business Practice Location Address Fax Number:
814-254-4446
Provider Enumeration Date:
01/18/2007