Provider First Line Business Practice Location Address:
140B STATE ROUTE 104
Provider Second Line Business Practice Location Address:
OSWEGO PLAZA
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:
315-342-0727
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/22/2011