Provider First Line Business Practice Location Address:
5939 LINGLESTOWN RD FL 2
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:
17112-1125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-407-3939
Provider Business Practice Location Address Fax Number:
888-830-7901
Provider Enumeration Date:
07/27/2020