Provider First Line Business Practice Location Address:
322 WARREN STREET
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15905-3443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-254-1230
Provider Business Practice Location Address Fax Number:
814-254-1236
Provider Enumeration Date:
10/06/2006