Provider First Line Business Practice Location Address:
53 59 PUBLIC SQ
Provider Second Line Business Practice Location Address:
WOODRUFF PROFF BLDG
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-782-7872
Provider Business Practice Location Address Fax Number:
315-782-7871
Provider Enumeration Date:
09/06/2006