Provider First Line Business Practice Location Address:
2416 GREEN STRREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-234-8494
Provider Business Practice Location Address Fax Number:
717-234-4415
Provider Enumeration Date:
06/18/2008