Provider First Line Business Practice Location Address:
650 N 12TH 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:
17101-2818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-525-9052
Provider Business Practice Location Address Fax Number:
877-753-9638
Provider Enumeration Date:
11/21/2022