Provider First Line Business Practice Location Address:
316 MILLER ST
Provider Second Line Business Practice Location Address:
KELLY INTERMEDIATE SCHOOL
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14513-1863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-332-3328
Provider Business Practice Location Address Fax Number:
315-332-3329
Provider Enumeration Date:
02/19/2013