Provider First Line Business Practice Location Address:
104 W UTICA ST
Provider Second Line Business Practice Location Address:
SUITE1A
Provider Business Practice Location Address City Name:
OSWEGO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13126-3031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-342-1390
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2010