Provider First Line Business Practice Location Address:
138 NORTH COURT ST
Provider Second Line Business Practice Location Address:
BLDG #5
Provider Business Practice Location Address City Name:
WAMPSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13163-0605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-366-2501
Provider Business Practice Location Address Fax Number:
315-366-2566
Provider Enumeration Date:
03/21/2007