Provider First Line Business Practice Location Address:
1110 SCALP AVE
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:
15904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-266-6888
Provider Business Practice Location Address Fax Number:
814-262-0267
Provider Enumeration Date:
02/06/2006