Provider First Line Business Practice Location Address:
8040 CARLSON RD
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:
17112-9706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-671-6566
Provider Business Practice Location Address Fax Number:
888-296-4002
Provider Enumeration Date:
07/20/2005