Provider First Line Business Practice Location Address:
148 PRAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OGDENSBURG
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13669-4150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-393-3433
Provider Business Practice Location Address Fax Number:
315-393-3433
Provider Enumeration Date:
11/17/2005