Provider First Line Business Practice Location Address:
223 WASHINGTON ST
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:
13669-1515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-393-0493
Provider Business Practice Location Address Fax Number:
315-393-0568
Provider Enumeration Date:
10/14/2010