Provider First Line Business Practice Location Address:
132 WALNUT 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:
15901-1621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-535-8830
Provider Business Practice Location Address Fax Number:
814-536-3233
Provider Enumeration Date:
08/23/2021