Provider First Line Business Practice Location Address: 
ONE PARK PLACE - ELMIRA COLLEGE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
ELMIRA
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
14901
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
607-735-1752
    Provider Business Practice Location Address Fax Number: 
607-735-1198
    Provider Enumeration Date: 
02/14/2007