Provider First Line Business Practice Location Address:
865 EISENHOWER BLVD
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:
15904-3327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-266-8840
Provider Business Practice Location Address Fax Number:
814-266-2176
Provider Enumeration Date:
07/12/2006