Provider First Line Business Practice Location Address:
2103 NORTH THIRD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17110-1812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-236-4208
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2006