Provider First Line Business Practice Location Address:
1308 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:
13601-4532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-836-2017
Provider Business Practice Location Address Fax Number:
315-998-8121
Provider Enumeration Date:
11/02/2007