Provider First Line Business Practice Location Address:
447 EAST WATER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELMIRA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14901-3410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-733-3631
Provider Business Practice Location Address Fax Number:
607-733-5432
Provider Enumeration Date:
09/21/2006