Provider First Line Business Practice Location Address:
4807 JONESTOWN RD STE 141
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:
17109-1744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-695-6177
Provider Business Practice Location Address Fax Number:
717-695-4369
Provider Enumeration Date:
03/27/2007