Provider First Line Business Practice Location Address:
88 OSBORNE 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:
15905-4146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-536-7510
Provider Business Practice Location Address Fax Number:
814-536-7527
Provider Enumeration Date:
07/20/2005