Provider First Line Business Practice Location Address: 
549 OLD W CHOCOLATE AVE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
HERSHEY
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
17033-1640
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-534-1106
    Provider Business Practice Location Address Fax Number: 
717-533-9137
    Provider Enumeration Date: 
10/06/2006