Provider First Line Business Practice Location Address:
7983 PAXTON 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:
17111-5428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-561-1118
Provider Business Practice Location Address Fax Number:
717-564-9066
Provider Enumeration Date:
07/10/2007