Provider First Line Business Practice Location Address:
53 PINE ST
Provider Second Line Business Practice Location Address:
DEPOSIT FAMILY CARE CENTER
Provider Business Practice Location Address City Name:
DEPOSIT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13754-1301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-467-4195
Provider Business Practice Location Address Fax Number:
607-467-6219
Provider Enumeration Date:
09/21/2005