Provider First Line Business Practice Location Address: 
55 HAMILTON RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
CHAMBERSBURG
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
17201-8656
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-261-1218
    Provider Business Practice Location Address Fax Number: 
717-263-6571
    Provider Enumeration Date: 
03/23/2011