Provider First Line Business Practice Location Address:
117 HIGHBRIDGE ST
Provider Second Line Business Practice Location Address:
SUITE U-4
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13066-1948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-254-8280
Provider Business Practice Location Address Fax Number:
315-299-8671
Provider Enumeration Date:
05/14/2007