Provider First Line Business Practice Location Address:
1442 VERNON 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:
17104-1181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-441-6314
Provider Business Practice Location Address Fax Number:
717-441-2293
Provider Enumeration Date:
10/17/2006