Provider First Line Business Practice Location Address:
136 BROADWAY STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARANAC LAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12983-1404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-891-4471
Provider Business Practice Location Address Fax Number:
518-891-7238
Provider Enumeration Date:
05/14/2013