Provider First Line Business Practice Location Address:
2101 N FRONT ST
Provider Second Line Business Practice Location Address:
BUILDING II
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17110-1086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-703-4098
Provider Business Practice Location Address Fax Number:
717-703-4028
Provider Enumeration Date:
05/17/2006