Provider First Line Business Practice Location Address:
350 BUDFIELD ST
Provider Second Line Business Practice Location Address:
SUITE ONE
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15904-3214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-254-4262
Provider Business Practice Location Address Fax Number:
814-254-4323
Provider Enumeration Date:
04/28/2011