Provider First Line Business Practice Location Address:
1231 CONGRESS ST
Provider Second Line Business Practice Location Address:
BOX 308
Provider Business Practice Location Address City Name:
OGDENSBURG
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13669-3268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-393-2295
Provider Business Practice Location Address Fax Number:
315-393-9604
Provider Enumeration Date:
07/01/2005