Provider First Line Business Practice Location Address:
4400 LINGLESTOWN RD 108
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:
17112-8534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-500-1203
Provider Business Practice Location Address Fax Number:
717-406-1567
Provider Enumeration Date:
02/09/2011