Provider First Line Business Practice Location Address:
131 MAIN STREET
Provider Second Line Business Practice Location Address:
COUNTY HIGHWAY ROUTE 10
Provider Business Practice Location Address City Name:
SHARON SPRINGS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13459-0265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-284-2357
Provider Business Practice Location Address Fax Number:
518-284-2357
Provider Enumeration Date:
01/11/2007