Provider First Line Business Practice Location Address:
5525 LOCUST LANE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-652-6352
Provider Business Practice Location Address Fax Number:
717-541-0771
Provider Enumeration Date:
10/27/2006