Provider First Line Business Practice Location Address:
4076 MARKET ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
CAMP HILL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17011-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-920-1501
Provider Business Practice Location Address Fax Number:
717-920-1502
Provider Enumeration Date:
09/26/2007