Provider First Line Business Practice Location Address:
25 LAKE AVE.
Provider Second Line Business Practice Location Address:
POB 481
Provider Business Practice Location Address City Name:
LYNDONVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14098-0481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-765-2562
Provider Business Practice Location Address Fax Number:
585-765-2198
Provider Enumeration Date:
12/04/2006