Provider First Line Business Practice Location Address: 
CORNELL UNIVERSITY HEALTH SERVICES
    Provider Second Line Business Practice Location Address: 
HO PLAZA
    Provider Business Practice Location Address City Name: 
ITHACA
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
14853-3101
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
607-255-6946
    Provider Business Practice Location Address Fax Number: 
607-254-3503
    Provider Enumeration Date: 
02/02/2006