Provider First Line Business Practice Location Address:
11 FOURTH STREEET
Provider Second Line Business Practice Location Address:
SUITE F HILLSIDE COMMONS
Provider Business Practice Location Address City Name:
OSWEGO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13126-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-342-7360
Provider Business Practice Location Address Fax Number:
315-342-7620
Provider Enumeration Date:
07/28/2006