Provider First Line Business Practice Location Address:
4129 LOCUST LN
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:
17109-4120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-657-3326
Provider Business Practice Location Address Fax Number:
717-909-0606
Provider Enumeration Date:
09/18/2008