Provider First Line Business Practice Location Address:
2723 AGATE 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:
17110-2645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-213-3708
Provider Business Practice Location Address Fax Number:
717-213-0095
Provider Enumeration Date:
08/02/2006