Provider First Line Business Practice Location Address:
398 OLD ITHACA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HORSEHEADS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14845-7202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-739-3591
Provider Business Practice Location Address Fax Number:
646-760-7391
Provider Enumeration Date:
09/08/2026