Provider First Line Business Practice Location Address: 
1685 CROWN AVE
    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: 
17601-6322
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-481-7645
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/07/2015