Provider First Line Business Practice Location Address:
1000 BRIARSDALE RD
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17109-5900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-495-0101
Provider Business Practice Location Address Fax Number:
610-495-0638
Provider Enumeration Date:
06/18/2008