Provider First Line Business Practice Location Address:
118 CANAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARTHAGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13619-1651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-493-1550
Provider Business Practice Location Address Fax Number:
315-493-0843
Provider Enumeration Date:
01/05/2012