Provider First Line Business Practice Location Address:
3731 WALNUT ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17109-2555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-545-3187
Provider Business Practice Location Address Fax Number:
717-920-9402
Provider Enumeration Date:
01/17/2014