Provider First Line Business Practice Location Address:
7619 STATE HIGHWAY 80
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COOPERSTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13326-3315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-858-5494
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2007