Provider First Line Business Practice Location Address:
149 MAIN ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
COOPERSTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13326-1224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-725-7314
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2006