Provider First Line Business Practice Location Address:
ROUTE 23 A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TANNERSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-589-5060
Provider Business Practice Location Address Fax Number:
518-589-5470
Provider Enumeration Date:
01/16/2007