Provider First Line Business Practice Location Address:
100 E MILLER ST
Provider Second Line Business Practice Location Address:
MUNICIPAL BUILDING - 4TH FLOOR
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14513-1525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-332-3217
Provider Business Practice Location Address Fax Number:
315-332-3517
Provider Enumeration Date:
12/28/2006