Provider First Line Business Practice Location Address: 
2755 LEWISBERRY RD
    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: 
17404-1317
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-764-4546
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
11/06/2014