Provider First Line Business Practice Location Address:
2023 N 2ND ST
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17102-2151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-575-6971
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/11/2006