Provider First Line Business Practice Location Address: 
1297 SCHAEFFER RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
NEWMANSTOWN
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
17073-7023
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-949-4138
    Provider Business Practice Location Address Fax Number: 
717-949-4140
    Provider Enumeration Date: 
10/05/2021