Provider First Line Business Practice Location Address:
995 STATE RT 26
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-837-4299
Provider Business Practice Location Address Fax Number:
315-837-4645
Provider Enumeration Date:
10/17/2005