Provider First Line Business Practice Location Address:
128 EAST AZALEA DRIVE
Provider Second Line Business Practice Location Address:
GREEN BLDG.
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-238-7455
Provider Business Practice Location Address Fax Number:
717-238-8793
Provider Enumeration Date:
04/20/2007