Provider First Line Business Practice Location Address:
45 HADJIS WAY
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
LAKE PLACID
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12946-1270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-523-3142
Provider Business Practice Location Address Fax Number:
518-523-1580
Provider Enumeration Date:
04/22/2011