Provider First Line Business Practice Location Address:
242 MACLAY ST UNIT 1
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:
17110-1829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
223-327-7850
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2026