Provider First Line Business Practice Location Address:
703 E MAPLE AVE
Provider Second Line Business Practice Location Address:
FLDDSO ARTICLE 16 CLINIC
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-331-1700
Provider Business Practice Location Address Fax Number:
315-331-3946
Provider Enumeration Date:
03/06/2007