Provider First Line Business Practice Location Address:
625 FORSTER ST
Provider Second Line Business Practice Location Address:
HEALTH & WELFARE BUILDING, ROOM 933
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17120-0701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-787-3350
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2006