Provider First Line Business Practice Location Address:
5600 DERRY ST STE B
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:
17111-3518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-727-6327
Provider Business Practice Location Address Fax Number:
717-525-9946
Provider Enumeration Date:
03/08/2007