Provider First Line Business Practice Location Address: 
2645 N 3RD 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: 
17110-2001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-782-2329
    Provider Business Practice Location Address Fax Number: 
717-782-2709
    Provider Enumeration Date: 
06/12/2009