Provider First Line Business Practice Location Address: 
350 N SIXTH AVENUE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
LEBANON
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
17046-4065
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-274-9686
    Provider Business Practice Location Address Fax Number: 
717-274-9549
    Provider Enumeration Date: 
05/06/2009