Provider First Line Business Practice Location Address:
160 S PROGRESS AVE STE 2C
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:
17109-4636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-443-6231
Provider Business Practice Location Address Fax Number:
610-363-8273
Provider Enumeration Date:
06/18/2020