Provider First Line Business Practice Location Address:
1956 CHRISTOPHER PL
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:
17110-3576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-302-2014
Provider Business Practice Location Address Fax Number:
717-302-2791
Provider Enumeration Date:
06/16/2005