Provider First Line Business Practice Location Address: 
501 MARKET ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
LEWISBURG
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
17837-3002
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
570-524-0900
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
05/14/2007