Provider First Line Business Practice Location Address:
1233 BROAD 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:
15906-2440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-535-4496
Provider Business Practice Location Address Fax Number:
814-536-6968
Provider Enumeration Date:
10/28/2021