Provider First Line Business Practice Location Address:
355 N 21ST ST
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
CAMP HILL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17011-3707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-525-7204
Provider Business Practice Location Address Fax Number:
717-525-7304
Provider Enumeration Date:
01/24/2012