Provider First Line Business Practice Location Address:
501 MITCHELL ST.
Provider Second Line Business Practice Location Address:
BELLE SHERMAN ELEMENTARY SCHOOL
Provider Business Practice Location Address City Name:
ITHACA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-274-2303
Provider Business Practice Location Address Fax Number:
607-274-7545
Provider Enumeration Date:
11/18/2011