Provider First Line Business Practice Location Address:
501 MITCHELL ST
Provider Second Line Business Practice Location Address:
BELLE SHERMAN ELEMENTARY SCHOOL
Provider Business Practice Location Address City Name:
ITHACA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14850-6148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-274-2107
Provider Business Practice Location Address Fax Number:
607-272-4059
Provider Enumeration Date:
12/08/2011