Provider First Line Business Practice Location Address:
2 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12095-2623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-762-8319
Provider Business Practice Location Address Fax Number:
518-762-5272
Provider Enumeration Date:
05/18/2017