Provider First Line Business Practice Location Address:
304 N PAXTANG AVE
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:
17111-1842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-982-8420
Provider Business Practice Location Address Fax Number:
717-564-6212
Provider Enumeration Date:
07/26/2005