Provider First Line Business Practice Location Address:
214 KING STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-713-5720
Provider Business Practice Location Address Fax Number:
315-713-5741
Provider Enumeration Date:
11/04/2019