Provider First Line Business Practice Location Address:
67 KENDALL ST
Provider Second Line Business Practice Location Address:
120 CLIFTON SPRINGS PROFESSIONAL PARK
Provider Business Practice Location Address City Name:
CLIFTON SPRINGS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14432-9701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-462-5633
Provider Business Practice Location Address Fax Number:
315-462-3196
Provider Enumeration Date:
11/10/2005