Provider First Line Business Practice Location Address:
30 HILLSIDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSWEGO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-216-4416
Provider Business Practice Location Address Fax Number:
315-216-4416
Provider Enumeration Date:
10/31/2008