Provider First Line Business Practice Location Address: 
21 GEISINGER LN
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
LEWISTOWN
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
17044-3400
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-242-4200
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
02/02/2023