Provider First Line Business Practice Location Address:
25 OWL AVENUE
Provider Second Line Business Practice Location Address:
MADISON ELEMENTARY SCHOOL
Provider Business Practice Location Address City Name:
MASSENA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-764-3740
Provider Business Practice Location Address Fax Number:
315-764-3743
Provider Enumeration Date:
12/17/2013