Provider First Line Business Practice Location Address:
183 E 6TH ST
Provider Second Line Business Practice Location Address:
APT 2
Provider Business Practice Location Address City Name:
OSWEGO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13126-3214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-591-1031
Provider Business Practice Location Address Fax Number:
315-963-5449
Provider Enumeration Date:
01/11/2010