Provider First Line Business Practice Location Address:
5112 WEST TAFT RD. DEPT OF MEDICINE MEDICAL SERVICE GRO
Provider Second Line Business Practice Location Address:
SUITE U
Provider Business Practice Location Address City Name:
LIVERPOOL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-701-2171
Provider Business Practice Location Address Fax Number:
315-701-2185
Provider Enumeration Date:
12/26/2024