Provider First Line Business Practice Location Address:
160 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENN YAN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14527-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-536-2752
Provider Business Practice Location Address Fax Number:
315-536-4005
Provider Enumeration Date:
04/14/2006