Provider First Line Business Practice Location Address:
340 WOODBINE 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:
17110-1857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-585-9390
Provider Business Practice Location Address Fax Number:
717-889-0254
Provider Enumeration Date:
05/19/2012