Provider First Line Business Practice Location Address:
110 S 17TH ST
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:
17104-1123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-232-9971
Provider Business Practice Location Address Fax Number:
717-920-3039
Provider Enumeration Date:
01/14/2019