Provider First Line Business Practice Location Address:
1000 BRIARSDALE RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17109-5900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-558-0243
Provider Business Practice Location Address Fax Number:
717-558-9878
Provider Enumeration Date:
03/17/2008