Provider First Line Business Practice Location Address:
548 S 17TH 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:
17104-2223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-695-7919
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2019