Provider First Line Business Practice Location Address:
5125 JONESTOWN RD
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:
17112-2990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-822-4588
Provider Business Practice Location Address Fax Number:
804-965-0987
Provider Enumeration Date:
03/15/2011