Provider First Line Business Practice Location Address:
2001 BEDFORD ST STE C
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:
15904-1096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-269-1494
Provider Business Practice Location Address Fax Number:
814-266-8572
Provider Enumeration Date:
08/31/2020