Provider First Line Business Practice Location Address:
104 S WILLIAM 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:
12095-2420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-762-6326
Provider Business Practice Location Address Fax Number:
518-762-2786
Provider Enumeration Date:
03/23/2007