Provider First Line Business Practice Location Address:
10 SPRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OGDENSBURG
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13669-3152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-393-5073
Provider Business Practice Location Address Fax Number:
315-394-0414
Provider Enumeration Date:
09/20/2005