Provider First Line Business Practice Location Address:
153 OAKDALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13790-1007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-748-9001
Provider Business Practice Location Address Fax Number:
607-748-8546
Provider Enumeration Date:
09/25/2006