Provider First Line Business Practice Location Address:
145 CLINTON STREET
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13601-3621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-782-0110
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2007