Provider First Line Business Practice Location Address:
KIM A VITACCO ANP-C
Provider Second Line Business Practice Location Address:
2 SHELTER HARBOR COURT
Provider Business Practice Location Address City Name:
WADING RIVER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11792-2202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-886-1668
Provider Business Practice Location Address Fax Number:
631-886-1909
Provider Enumeration Date:
08/09/2005