Provider First Line Business Practice Location Address: 
867 YORK RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
GETTYSBURG
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
17325-7501
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-338-5106
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
11/14/2008