Provider First Line Business Practice Location Address:
1340 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13601-4541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-782-9003
Provider Business Practice Location Address Fax Number:
315-782-9010
Provider Enumeration Date:
06/13/2005