Individual
ANDREW RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3226 WILKINS RD, ITHACA, NY 14850-9568
(607) 272-5891
(607) 272-0188
Mailing address
3226 WILKINS RD, ITHACA, NY 14850-9568
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
06/22/2012
Last updated
06/22/2012
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