Provider First Line Business Practice Location Address:
4800 DERRY 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:
17111-3440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-564-1550
Provider Business Practice Location Address Fax Number:
717-561-1744
Provider Enumeration Date:
05/16/2007