Provider First Line Business Practice Location Address:
116 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:
14527-1806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-377-2354
Provider Business Practice Location Address Fax Number:
607-292-6810
Provider Enumeration Date:
01/30/2007