Provider First Line Business Practice Location Address:
2187 COUNTY RTE. 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRAL SQUARE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-668-9532
Provider Business Practice Location Address Fax Number:
315-668-0164
Provider Enumeration Date:
07/09/2015