Provider First Line Business Practice Location Address:
760 COOPER 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:
15906-1033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-536-2111
Provider Business Practice Location Address Fax Number:
814-535-7556
Provider Enumeration Date:
04/18/2007