Provider First Line Business Practice Location Address: 
1665 ROOSEVELT AVE
    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: 
17408-8549
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-747-8350
    Provider Business Practice Location Address Fax Number: 
717-430-8827
    Provider Enumeration Date: 
08/09/2023