Provider First Line Business Practice Location Address:
891 MENOHER BLVD
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:
15905-2839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-534-3119
Provider Business Practice Location Address Fax Number:
814-539-4137
Provider Enumeration Date:
02/16/2009