Provider First Line Business Practice Location Address:
159 FAIR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARGARETVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12455-2822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-796-7555
Provider Business Practice Location Address Fax Number:
516-566-2395
Provider Enumeration Date:
10/04/2005