Provider First Line Business Practice Location Address:
RTE 22 AND COLONIAL RD
Provider Second Line Business Practice Location Address:
COLONIAL PARK MALL STE #74
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17109-6234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-657-7777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2006