Provider First Line Business Practice Location Address:
6122 MINGLEWOOD RD
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:
17112-8521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-540-1562
Provider Business Practice Location Address Fax Number:
717-671-5518
Provider Enumeration Date:
03/08/2012