Provider First Line Business Practice Location Address:
238 UPHAM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13072-3179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-837-4356
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2009