Provider First Line Business Practice Location Address:
491A BLUE EAGLE AVE
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:
17112-2314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-651-9996
Provider Business Practice Location Address Fax Number:
717-651-9974
Provider Enumeration Date:
05/05/2010