Provider First Line Business Practice Location Address:
1624 BERKSHIRE LN
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:
17111-6887
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-671-7022
Provider Business Practice Location Address Fax Number:
717-671-7023
Provider Enumeration Date:
07/05/2005