Provider First Line Business Practice Location Address:
1315 N MOUNTAIN 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:
17112-1757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-652-4672
Provider Business Practice Location Address Fax Number:
717-652-2680
Provider Enumeration Date:
03/19/2007