Provider First Line Business Practice Location Address:
339 WALNUT ST
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15901-1731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-535-3203
Provider Business Practice Location Address Fax Number:
814-539-2200
Provider Enumeration Date:
06/11/2006