Provider First Line Business Practice Location Address:
119 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:
15901-1625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-534-0745
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2019