Provider First Line Business Practice Location Address:
11 NORTH STREET
Provider Second Line Business Practice Location Address:
EDMESTON HEATLHZONE
Provider Business Practice Location Address City Name:
EDMESTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13335-3014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-965-6930
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2009