Provider First Line Business Practice Location Address:
12 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANDOR
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13743-0071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-659-4050
Provider Business Practice Location Address Fax Number:
607-659-4644
Provider Enumeration Date:
10/24/2005