Provider First Line Business Practice Location Address: 
211 TALL OAK DR
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
NEW CUMBERLAND
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
17070-2347
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-737-5200
    Provider Business Practice Location Address Fax Number: 
717-737-5200
    Provider Enumeration Date: 
11/16/2005