Provider First Line Business Practice Location Address: 
8 PATTERSON ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
SIDNEY
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
13838-1015
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
607-244-7640
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
02/27/2015