Provider First Line Business Practice Location Address: 
625 COMMUNITY WAY
    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: 
17603-2301
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-393-0425
    Provider Business Practice Location Address Fax Number: 
717-392-7107
    Provider Enumeration Date: 
04/11/2006