Provider First Line Business Practice Location Address:
3000 FORD STREET EXT
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:
13669-4480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-394-9592
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2006