Provider First Line Business Practice Location Address:
42084 NEW YORK 28
Provider Second Line Business Practice Location Address:
BOX 200
Provider Business Practice Location Address City Name:
MARGARETVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12455-0200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-652-2140
Provider Business Practice Location Address Fax Number:
607-652-2141
Provider Enumeration Date:
01/13/2010