Provider First Line Business Practice Location Address:
160 S PROGRESS AVE #3A
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:
17109-4636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-473-0531
Provider Business Practice Location Address Fax Number:
904-216-8269
Provider Enumeration Date:
07/29/2005