Provider First Line Business Practice Location Address:
133 LINGLESTOWN 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:
17110-1627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-503-7862
Provider Business Practice Location Address Fax Number:
717-599-5197
Provider Enumeration Date:
03/29/2007