Provider First Line Business Practice Location Address:
110 HO PLAZA
Provider Second Line Business Practice Location Address:
GANNETT HEALTH CENTER
Provider Business Practice Location Address City Name:
ITHACA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14853-5169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-255-5155
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2011