Provider First Line Business Practice Location Address:
168 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13664-3222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-375-8543
Provider Business Practice Location Address Fax Number:
315-375-4589
Provider Enumeration Date:
09/20/2005