Provider First Line Business Practice Location Address:
145 CLINTON STREET
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13601-3664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-788-3240
Provider Business Practice Location Address Fax Number:
315-788-1279
Provider Enumeration Date:
04/25/2012