Provider First Line Business Practice Location Address:
312 KING STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OGDENSBURG
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-393-1144
Provider Business Practice Location Address Fax Number:
315-393-1476
Provider Enumeration Date:
11/08/2006