Provider First Line Business Practice Location Address:
100 SOUTH SECOND STREET SUITE 4B
Provider Second Line Business Practice Location Address:
MEDICAL SCIENCES BUILDING
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17101-2541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-231-8472
Provider Business Practice Location Address Fax Number:
717-231-8490
Provider Enumeration Date:
01/25/2006