Provider First Line Business Practice Location Address:
2595 INTERSTATE DRIVE
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:
17110-9380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-832-2279
Provider Business Practice Location Address Fax Number:
860-510-0020
Provider Enumeration Date:
10/19/2009