Provider First Line Business Practice Location Address:
800 JEFFERSON AVE
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:
13669-3026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-393-7729
Provider Business Practice Location Address Fax Number:
315-393-0419
Provider Enumeration Date:
12/23/2011