Provider First Line Business Practice Location Address:
1000 S 21ST ST
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:
17104-2705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-961-7743
Provider Business Practice Location Address Fax Number:
717-652-3461
Provider Enumeration Date:
10/10/2016