Provider First Line Business Practice Location Address: 
220 GRANDVIEW AVE
    Provider Second Line Business Practice Location Address: 
STE 200
    Provider Business Practice Location Address City Name: 
CAMP HILL
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
17011-1740
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-761-8688
    Provider Business Practice Location Address Fax Number: 
717-761-5604
    Provider Enumeration Date: 
06/04/2007