Provider First Line Business Practice Location Address:
1199 COLONIAL RD
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:
17112-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-652-8436
Provider Business Practice Location Address Fax Number:
717-652-8804
Provider Enumeration Date:
06/30/2005