Provider First Line Business Practice Location Address: 
1693 S QUEEN 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: 
17403-4609
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-845-1621
    Provider Business Practice Location Address Fax Number: 
717-845-6939
    Provider Enumeration Date: 
10/04/2006