Provider First Line Business Practice Location Address: 
417 W SOUTH ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
CARLISLE
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
17013-2829
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
717-249-1069
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
01/09/2021