Provider First Line Business Practice Location Address:
28 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLIFTON SPRINGS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-462-9466
Provider Business Practice Location Address Fax Number:
315-462-6400
Provider Enumeration Date:
08/18/2005