Provider First Line Business Practice Location Address:
3540 N PROGRESS AVE
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17110-9481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-652-5288
Provider Business Practice Location Address Fax Number:
717-652-8209
Provider Enumeration Date:
02/21/2006