Provider First Line Business Practice Location Address:
419 FORD 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:
13669-1619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-393-6544
Provider Business Practice Location Address Fax Number:
315-393-9061
Provider Enumeration Date:
02/13/2007