Provider First Line Business Practice Location Address:
4518 UNION DEPOSIT RD
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:
17111-2921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-991-5030
Provider Business Practice Location Address Fax Number:
717-540-0845
Provider Enumeration Date:
07/28/2006