Provider First Line Business Practice Location Address:
159 W 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSWEGO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13126-2045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-342-9575
Provider Business Practice Location Address Fax Number:
315-342-7664
Provider Enumeration Date:
01/23/2009