Provider First Line Business Practice Location Address:
7060 STATE ROUTE 104
Provider Second Line Business Practice Location Address:
SUNY OSWEGO
Provider Business Practice Location Address City Name:
OSWEGO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13126-3501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-312-4100
Provider Business Practice Location Address Fax Number:
315-312-5409
Provider Enumeration Date:
06/24/2009