Provider First Line Business Practice Location Address:
12 FRANKLIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13323-1616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-853-3980
Provider Business Practice Location Address Fax Number:
315-853-3983
Provider Enumeration Date:
02/19/2010