Provider First Line Business Practice Location Address:
135 N COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAMPSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13163-7713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-280-0586
Provider Business Practice Location Address Fax Number:
315-282-2332
Provider Enumeration Date:
09/07/2023