Provider First Line Business Practice Location Address:
214 KING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OGDENSBURG
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13669-1142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-713-5730
Provider Business Practice Location Address Fax Number:
315-713-5389
Provider Enumeration Date:
06/07/2022