Provider First Line Business Practice Location Address: 
3399 TRINDLE RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
CAMP HILL
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
17011
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-761-5530
    Provider Business Practice Location Address Fax Number: 
717-737-7197
    Provider Enumeration Date: 
08/01/2006