Provider First Line Business Practice Location Address:
111 SOUTH FRONT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17111-8700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-782-5640
Provider Business Practice Location Address Fax Number:
717-782-5352
Provider Enumeration Date:
08/30/2005