Provider First Line Business Practice Location Address:
1200 STATE ROUTE 92 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUNKHANNOCK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
18657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-388-6155
Provider Business Practice Location Address Fax Number:
570-388-6979
Provider Enumeration Date:
10/18/2010