Provider First Line Business Practice Location Address:
16163 COUNTY ROUTE 156
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13601-5746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-779-2828
Provider Business Practice Location Address Fax Number:
315-782-5813
Provider Enumeration Date:
11/16/2006