Provider First Line Business Practice Location Address:
12 CTY RT 47
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARISHVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-265-5579
Provider Business Practice Location Address Fax Number:
315-268-1309
Provider Enumeration Date:
01/25/2007