Provider First Line Business Practice Location Address:
109 WASHINGTON ST
Provider Second Line Business Practice Location Address:
WATERLOO CENTRAL SCHOOL DISTRICT
Provider Business Practice Location Address City Name:
WATERLOO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13165-1835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-539-1520
Provider Business Practice Location Address Fax Number:
315-539-1527
Provider Enumeration Date:
03/29/2012