Provider First Line Business Practice Location Address:
52 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43031-1225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-967-0020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2007