Provider First Line Business Practice Location Address:
2215 FOREST HILLS DR
Provider Second Line Business Practice Location Address:
SUITE 38
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17112-1099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-540-5353
Provider Business Practice Location Address Fax Number:
717-540-5151
Provider Enumeration Date:
10/09/2006