Provider First Line Business Practice Location Address:
114 S SHORE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLD FORGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13420-3500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-369-6619
Provider Business Practice Location Address Fax Number:
315-369-6533
Provider Enumeration Date:
12/15/2005