Provider First Line Business Practice Location Address:
128 BOYNTON AVENUE
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
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
518-324-3399
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/22/2007