Provider First Line Business Practice Location Address:
145 OAKDALE ROAD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13790-1766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-217-5853
Provider Business Practice Location Address Fax Number:
607-237-0159
Provider Enumeration Date:
04/11/2007