Provider First Line Business Practice Location Address:
96 NASH STREET
Provider Second Line Business Practice Location Address:
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-523-2020
Provider Business Practice Location Address Fax Number:
518-523-3691
Provider Enumeration Date:
04/23/2007