Provider First Line Business Practice Location Address: 
1929 GOLDEN EAGLE DR
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
YORK
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
17408-9485
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-792-1933
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/08/2010