Provider First Line Business Practice Location Address:
2405 LINGLESTOWN RD STE 6
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:
17110-9429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-710-3122
Provider Business Practice Location Address Fax Number:
814-710-3123
Provider Enumeration Date:
11/12/2019