Provider First Line Business Practice Location Address:
42084 ROUTE 28
Provider Second Line Business Practice Location Address:
BOX 200
Provider Business Practice Location Address City Name:
MARGARETVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12455-0200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-334-5010
Provider Business Practice Location Address Fax Number:
607-336-7326
Provider Enumeration Date:
09/12/2011