Provider First Line Business Practice Location Address: 
117 WEST MAIN STREET
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
NEW HOLLAND
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
17557
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-354-2020
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
09/28/2017