Provider First Line Business Practice Location Address:
5405 JONESTOWN RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17112-4021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-671-9520
Provider Business Practice Location Address Fax Number:
717-671-9524
Provider Enumeration Date:
11/16/2006