Provider First Line Business Practice Location Address:
389 COUNTY ROUTE 1A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSWEGO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13126-5931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-342-2287
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/07/2010