Provider First Line Business Practice Location Address:
112 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENN YAN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14527-1219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-531-1560
Provider Business Practice Location Address Fax Number:
315-536-8652
Provider Enumeration Date:
06/10/2006