Provider First Line Business Practice Location Address:
209 OSWEGO ST
Provider Second Line Business Practice Location Address:
SPACE#13
Provider Business Practice Location Address City Name:
LIVERPOOL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13088-1502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-457-7047
Provider Business Practice Location Address Fax Number:
315-457-0719
Provider Enumeration Date:
12/31/2014