Provider First Line Business Practice Location Address:
90 W UTICA ST
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
OSWEGO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13126-3048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-342-8552
Provider Business Practice Location Address Fax Number:
315-342-8572
Provider Enumeration Date:
07/21/2006