Provider First Line Business Practice Location Address:
120 WILLOW RD STE B
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:
17109-2602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-657-4804
Provider Business Practice Location Address Fax Number:
717-657-8683
Provider Enumeration Date:
01/16/2007