Provider First Line Business Practice Location Address:
101 103 MAIN STREET
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:
13326-1286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-547-1130
Provider Business Practice Location Address Fax Number:
607-547-1130
Provider Enumeration Date:
06/05/2008