Provider First Line Business Practice Location Address:
423 N 21ST ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
CAMP HILL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17011-2207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-975-2430
Provider Business Practice Location Address Fax Number:
717-730-2158
Provider Enumeration Date:
07/15/2005