Individual
ALLIE MACKENSIE RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
159 W 1ST ST, OSWEGO, NY 13126-2045
(315) 342-9575
Mailing address
5820 HERITAGE LANDING DR, EAST SYRACUSE, NY 13057-9378
(315) 701-1107
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
01/30/2017
Last updated
01/30/2017
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