Provider First Line Business Practice Location Address:
4400 LINGLESTOWN 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:
17112-8507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-919-6399
Provider Business Practice Location Address Fax Number:
513-277-7433
Provider Enumeration Date:
05/19/2010