Provider First Line Business Practice Location Address:
369 E. MAIN STREET
Provider Second Line Business Practice Location Address:
HUNTINGTON LIVING CENTER
Provider Business Practice Location Address City Name:
WATERLOO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-539-9202
Provider Business Practice Location Address Fax Number:
315-539-3495
Provider Enumeration Date:
08/09/2012