Provider First Line Business Practice Location Address: 
2319 S GEORGE ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
YORK
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
17403-5009
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-812-4090
    Provider Business Practice Location Address Fax Number: 
717-741-3554
    Provider Enumeration Date: 
08/19/2016