Provider First Line Business Practice Location Address:
2578 INTERSTATE DR STE 104
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:
17110-9301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-857-3997
Provider Business Practice Location Address Fax Number:
888-400-2934
Provider Enumeration Date:
11/17/2019