Provider First Line Business Practice Location Address:
2924 COUNTY ROUTE 17
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEKALB JUNCTION
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-347-3830
Provider Business Practice Location Address Fax Number:
315-347-3840
Provider Enumeration Date:
12/21/2006