Provider First Line Business Practice Location Address:
17 KNOX ST
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:
15906-1021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-241-9342
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2023