Provider First Line Business Practice Location Address:
5370 STATE HIGHWAY 28
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COOPERSTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13326-5710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-547-8080
Provider Business Practice Location Address Fax Number:
607-547-2152
Provider Enumeration Date:
10/11/2006