Provider First Line Business Practice Location Address:
53 JOHNSON AVE UNIT 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLATTSBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12901-3747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-562-1972
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2008