Provider First Line Business Practice Location Address:
144 WASHINGTON ST
Provider Second Line Business Practice Location Address:
APT 1
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13021-1747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-729-8412
Provider Business Practice Location Address Fax Number:
315-729-8412
Provider Enumeration Date:
02/25/2010