Provider First Line Business Practice Location Address:
142 W 2ND ST
Provider Second Line Business Practice Location Address:
1 A
Provider Business Practice Location Address City Name:
OSWEGO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13126-2547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-216-4776
Provider Business Practice Location Address Fax Number:
315-216-4783
Provider Enumeration Date:
04/27/2012