Provider First Line Business Practice Location Address:
762 ROUTE 3
Provider Second Line Business Practice Location Address:
SUITE 14
Provider Business Practice Location Address City Name:
PLATTSBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12901-7472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-562-3204
Provider Business Practice Location Address Fax Number:
518-563-0707
Provider Enumeration Date:
04/27/2006