Provider First Line Business Practice Location Address:
154 W ALBANY 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:
13126-1928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-704-8333
Provider Business Practice Location Address Fax Number:
315-602-0113
Provider Enumeration Date:
08/25/2026