Provider First Line Business Practice Location Address:
3501 PAXTON ST UNIT H2
Provider Second Line Business Practice Location Address:
HARRISBURG MALL
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17111-1483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-561-6000
Provider Business Practice Location Address Fax Number:
717-561-1090
Provider Enumeration Date:
05/02/2006