Provider First Line Business Practice Location Address:
143 NORTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-253-4536
Provider Business Practice Location Address Fax Number:
315-253-8130
Provider Enumeration Date:
10/26/2005