Provider First Line Business Practice Location Address:
4310 LONDONDERRY ROAD
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17109-5317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-657-7556
Provider Business Practice Location Address Fax Number:
717-657-7558
Provider Enumeration Date:
08/10/2005