Provider First Line Business Practice Location Address:
1942 OLD DEKALB ROAD
Provider Second Line Business Practice Location Address:
ST LAWRENCE NYSARC ARTICLE 28 CLINIC
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-386-2647
Provider Business Practice Location Address Fax Number:
315-386-4071
Provider Enumeration Date:
10/24/2006