Provider First Line Business Practice Location Address:
4400 LEWIS RD
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17111-2544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-558-6708
Provider Business Practice Location Address Fax Number:
214-775-4502
Provider Enumeration Date:
03/28/2007