Provider First Line Business Practice Location Address: 
124 S FRONT ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
STEELTON
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
17113-2521
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-939-7272
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
12/05/2016