Provider First Line Business Practice Location Address:
6956 STATE HIGHWAY 56
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POTSDAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13676-3504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-268-0264
Provider Business Practice Location Address Fax Number:
315-268-8001
Provider Enumeration Date:
10/29/2006