Provider First Line Business Practice Location Address:
52 BOYNTON AVE
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:
12901-1235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-561-8667
Provider Business Practice Location Address Fax Number:
518-561-6739
Provider Enumeration Date:
03/15/2010