Provider First Line Business Practice Location Address:
101 W UTICA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSWEGO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13126-3165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-216-4871
Provider Business Practice Location Address Fax Number:
315-216-4875
Provider Enumeration Date:
08/19/2008