Provider First Line Business Practice Location Address: 
802 NEW HOLLAND AVE STE 200
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
LANCASTER
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
17602-2288
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-299-6371
    Provider Business Practice Location Address Fax Number: 
717-396-3897
    Provider Enumeration Date: 
12/14/2011