Provider First Line Business Practice Location Address:
208 LUNEN 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:
15902-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-535-8418
Provider Business Practice Location Address Fax Number:
814-535-8418
Provider Enumeration Date:
04/18/2015