Provider First Line Business Practice Location Address:
5920 STATE HIGHWAY 28
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COOPERSTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13326-2406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-544-1336
Provider Business Practice Location Address Fax Number:
607-544-1338
Provider Enumeration Date:
03/27/2007