Provider First Line Business Practice Location Address: 
SWATARA ST & REYNDERS AVE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
STEELTON
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
17113-7645
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-704-3800
    Provider Business Practice Location Address Fax Number: 
717-704-3808
    Provider Enumeration Date: 
07/07/2008