Provider First Line Business Practice Location Address:
101 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE #5
Provider Business Practice Location Address City Name:
COOPERSTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-547-1130
Provider Business Practice Location Address Fax Number:
607-547-1130
Provider Enumeration Date:
11/21/2006