Provider First Line Business Practice Location Address:
138 E. GENESEE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALDWINSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-635-2333
Provider Business Practice Location Address Fax Number:
315-635-3945
Provider Enumeration Date:
10/26/2006