Provider First Line Business Practice Location Address:
63 WEST SECOND STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-343-5945
Provider Business Practice Location Address Fax Number:
315-343-5955
Provider Enumeration Date:
05/24/2007