Provider First Line Business Practice Location Address:
157 EAST FIRST ST
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
OSWEGO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13126-2641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-216-4145
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2007