Provider First Line Business Practice Location Address:
4700 UNION DEPOSIT RD
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17111-3774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-540-1777
Provider Business Practice Location Address Fax Number:
717-540-6857
Provider Enumeration Date:
09/20/2005