Provider First Line Business Practice Location Address:
219 LAKE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENN YAN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-536-3700
Provider Business Practice Location Address Fax Number:
315-694-9085
Provider Enumeration Date:
11/01/2006