Provider First Line Business Practice Location Address:
201 OAKDALE RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13790-1143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-770-3870
Provider Business Practice Location Address Fax Number:
607-770-3872
Provider Enumeration Date:
08/17/2011