Provider First Line Business Practice Location Address:
13 N PROGRESS AVE
Provider Second Line Business Practice Location Address:
#216
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17109-3547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-540-8041
Provider Business Practice Location Address Fax Number:
717-540-8096
Provider Enumeration Date:
08/15/2008