Provider First Line Business Practice Location Address:
1923 STATE ST
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:
17103-1641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-695-9808
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2010