Provider First Line Business Practice Location Address:
69 W UTICA ST
Provider Second Line Business Practice Location Address:
APT 3
Provider Business Practice Location Address City Name:
OSWEGO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13126-3085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-321-4577
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/25/2012