Provider First Line Business Practice Location Address: 
3294 PLEASANT GROVE RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
WARFORDSBURG
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
17267-8818
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-573-2481
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
09/18/2009