Provider First Line Business Practice Location Address:
5405 JONESTOWN RD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17112-4021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-545-8412
Provider Business Practice Location Address Fax Number:
717-545-8413
Provider Enumeration Date:
12/24/2007