Provider First Line Business Practice Location Address:
3101 SHIPPERS ROAD SUITE 202
Provider Second Line Business Practice Location Address:
LOURDED PRIMARY CARE
Provider Business Practice Location Address City Name:
VESTAL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-251-2130
Provider Business Practice Location Address Fax Number:
607-754-5508
Provider Enumeration Date:
11/07/2005