Provider First Line Business Practice Location Address:
45 1/2 W BRIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSWEGO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13126-2024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-312-0097
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2019