Provider First Line Business Practice Location Address:
124 PINE ST
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:
17101-1208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-232-7509
Provider Business Practice Location Address Fax Number:
717-635-2560
Provider Enumeration Date:
03/15/2007