Provider First Line Business Practice Location Address:
9530 BREWERTON RD
Provider Second Line Business Practice Location Address:
BREWERTON ELEMENTARY SCHOOL
Provider Business Practice Location Address City Name:
BREWERTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13029-9788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-668-4201
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2011