Provider First Line Business Practice Location Address:
2014 GREEN ST REAR
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:
17102-2127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-836-1184
Provider Business Practice Location Address Fax Number:
717-754-0017
Provider Enumeration Date:
11/16/2018