Provider First Line Business Practice Location Address: 
75 ORISKANY BLVD.
    Provider Second Line Business Practice Location Address: 
WHITESBORO CENTRAL SCHOOL DISTRICT
    Provider Business Practice Location Address City Name: 
WHITESBORO
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
13492-9998
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
315-266-3100
    Provider Business Practice Location Address Fax Number: 
315-768-9770
    Provider Enumeration Date: 
06/23/2010